Healthcare utilization and costs in adults with stable and uncontrolled epilepsy.
Despite the availability of numerous antiepileptic drugs (AEDs), some epilepsies remain resistant to treatment. We compared utilization and costs in patients with uncontrolled epilepsy to those with stable epilepsy. Claims data (2007-2009) were used to identify adults with epilepsy requiring additional AED therapy (having uncontrolled epilepsy) and those not requiring additional AED therapy (having stable epilepsy). The date in 2008 on which an additional AED was started was the index date for patients with uncontrolled epilepsy, and a randomly selected date was used for patients with stable epilepsy, whose AED use was unchanged in the preceding year. In the postindex year, all pharmacy and medical claims were used to estimate overall utilization and costs; claims with epilepsy in any diagnosis field were used to estimate epilepsy-related outcomes. Outcomes were adjusted using multivariate analyses. We identified 1536 patients with uncontrolled epilepsy and 8571 patients with stable epilepsy (mean age: 42.8years; female: 48%). Patients with uncontrolled epilepsy had higher comorbidity rates (p<.02). A greater proportion of patients with uncontrolled epilepsy had ≥1 hospitalization or emergency department visit (p<.001). Patients with uncontrolled epilepsy had a greater mean length of hospital stay and more physician office visits (p<.034). After adjustment, the odds of hospitalization (OR: 1.8, any diagnosis; 2.2, epilepsy-related) and emergency department visit (OR: 1.6, any diagnosis; 1.9, epilepsy-related) were greater for patients with uncontrolled epilepsy. Annual overall ($23,238 vs. $13,839) and epilepsy-related ($12,399 vs. $5511) costs were higher in patients with uncontrolled epilepsy and remained higher after adjustment (p<.001). Patients with uncontrolled epilepsy use more services and incur higher costs compared with those with stable epilepsy. Epilepsy-related costs accounted for <50% of the total costs, suggesting that comorbid conditions and/or underidentification of utilization may substantially contribute to costs.
Yale University School of Medicine, New Haven, CT, USA. Electronic address: joyce.cramer@gmail.com.
Joyce A
JA
Cramer
Eisai Inc., 100 Tice Boulevard, Woodcliff Lake, NJ 07677, USA. Electronic address: Jason_Wang@eisai.com.
Zhixiao J
ZJ
Wang
Partnership for Health Analytic Research, LLC, 280 S. Beverly Drive, Suite 404, Beverly Hills, CA 90212, USA. Electronic address: echang@pharllc.com.
Eunice
E
Chang
Eisai Inc., 100 Tice Boulevard, Woodcliff Lake, NJ 07677, USA. Electronic address: Annette_Powers@eisai.com.
Annette
A
Powers
Eisai Inc., 100 Tice Boulevard, Woodcliff Lake, NJ 07677, USA. Electronic address: Ronda_Copher@eisai.com.
Ronda
R
Copher
Partnership for Health Analytic Research, LLC, 280 S. Beverly Drive, Suite 404, Beverly Hills, CA 90212, USA. Electronic address: dasha@pharllc.com.
Dasha
D
Cherepanov
Partnership for Health Analytic Research, LLC, 280 S. Beverly Drive, Suite 404, Beverly Hills, CA 90212, USA. Electronic address: mbroder@pharllc.com.
Michael S
MS
Broder
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000927:Anticonvulsants / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D016208:Databases, Factual / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D004827:Epilepsy / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D055815:Young Adult
D000927:Anticonvulsants
Antiepileptic drugs; Cost analysis; Economics; Epilepsy; Medical care; Seizures