title: Healthcare utilization and costs in children with stable and uncontrolled epilepsy.
abstract: OBJECTIVE
  Epilepsy adversely affects childhood development, possibly leading to increased economic burden in pediatric populations. We compared annual healthcare utilization and costs between children (<12 years old) with stable and uncontrolled epilepsy treated with antiepileptic drugs (AEDs).
  
  
  METHODS
  Children (<12 years old) with epilepsy (ICD-9-CM 345.xx or 780.39) in 2008 were identified in the MarketScan claims database from 2007 to 2009. Patients with "stable" epilepsy used the same AED for ≥12 months, and patients with "uncontrolled" epilepsy were prescribed additional AED(s) during that period. For patients with uncontrolled epilepsy, the study index date was the start of additional AED(s); for patients with stable epilepsy, the study index date was a random AED fill date. Epilepsy-related utilization included medical services with 345.xx or 780.39 in any diagnosis field and AED fills. Epilepsy-related costs included AEDs, medical claims with epilepsy in any diagnosis field, and certain tests. We adjusted for baseline cohort differences (demographics, region, usual-care physician specialty, and comorbidities) using logistic regression and analysis of covariance.
  
  
  RESULTS
  Two thousand one hundred seventy patients were identified (mean: 7.5 years; 45.3% were female; Charlson comorbidity index: 0.3; 422 (19.4%) patients with uncontrolled epilepsy). Patients with uncontrolled epilepsy faced more hospitalizations (30.1% vs. 12.0%) and greater overall ($30,343 vs. $18,206) and epilepsy-related costs ($16,894 vs. $7979) (all p<.001). Adjusting for baseline measures, patients with uncontrolled epilepsy had greater odds of hospitalization (OR: 2.5; 95% CI: 1.9-3.3) and costs (overall: $3908, p=.087; epilepsy-related: $5744, p<.001).
  
  
  CONCLUSIONS
  Children with uncontrolled epilepsy use significantly more healthcare resources and have a greater economic burden than children with stable epilepsy. However, epilepsy accounted for only half of overall costs, indicating that comorbid conditions may add substantially to the disease burden.
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA; Consultant, Houston, TX, USA. Electronic address: joyce.cramer@gmail.com.
authors.forename: Joyce A
authors.initials: JA
authors.lastname: Cramer
authors.affiliation: Eisai Inc., 100 Tice Boulevard, Woodcliff Lake, NJ 07677, USA. Electronic address: Jason_Wang@eisai.com.
authors.forename: Zhixiao J
authors.initials: ZJ
authors.lastname: Wang
authors.affiliation: Partnership for Health Analytic Research, LLC, 280 S. Beverly Drive, Suite 404, Beverly Hills, CA 90212, USA. Electronic address: echang@pharllc.com.
authors.forename: Eunice
authors.initials: E
authors.lastname: Chang
authors.affiliation: Eisai Inc., 100 Tice Boulevard, Woodcliff Lake, NJ 07677, USA. Electronic address: Annette_Powers@eisai.com.
authors.forename: Annette
authors.initials: A
authors.lastname: Powers
authors.affiliation: Eisai Inc., 100 Tice Boulevard, Woodcliff Lake, NJ 07677, USA. Electronic address: Ronda_Copher@eisai.com.
authors.forename: Ronda
authors.initials: R
authors.lastname: Copher
authors.affiliation: Partnership for Health Analytic Research, LLC, 280 S. Beverly Drive, Suite 404, Beverly Hills, CA 90212, USA. Electronic address: dasha@pharllc.com.
authors.forename: Dasha
authors.initials: D
authors.lastname: Cherepanov
authors.affiliation: Partnership for Health Analytic Research, LLC, 280 S. Beverly Drive, Suite 404, Beverly Hills, CA 90212, USA. Electronic address: mbroder@pharllc.com.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Broder
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003365:Costs and Cost Analysis; D004827:Epilepsy / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D012189:Retrospective Studies
chemical_list: D000927:Anticonvulsants
keywords: Antiepileptic drugs; Children; Comorbidities; Cost analysis; Economics; Epilepsy; Medical care; Pediatric epilepsy; Seizures