title: Newer antiepileptic drug use and other factors decreasing hospital encounters.
abstract: A retrospective analysis was conducted in one claims database and was confirmed in a second independent database (covering both commercial and government insurance plans between 11/2009 and 9/2011) for the understanding of factors influencing antiepileptic drug (AED) use and the role of AEDs and other health-care factors in hospital encounters. In both datasets, epilepsy cases were identified by AED use and epilepsy diagnosis coding. Variables analyzed for effect on hospitalization rates were as follows: (1) use of first-generation AEDs or second-generation AEDs, (2) treatment changes, and (3) factors that may affect AED choice. Lower rates of epilepsy-related hospital encounters (encounters with an epilepsy diagnosis code) were associated with use of second-generation AEDs, deliberate treatment changes, and treatment by a neurologist. Epilepsy-related hospital encounters were more frequent for patients not receiving an AED and for those with greater comorbidities. On average, patients taking ≥1 first-generation AED experienced epilepsy-related hospitalizations every 684days, while those taking ≥1second-generation AED were hospitalized every 1001days (relative risk reduction of 31%, p<0.01). Prescriptions for second-generation AEDs were more common among neurologists and among physicians near an epilepsy center. Use of second-generation AEDs, access to specialty care, and deliberate efforts to change medications following epilepsy-related hospital encounters improved outcomes of epilepsy treatment based on average time between epilepsy-related hospital encounters. These factors may be enhanced by public health policies, private insurance reimbursement policies, and education of patients and physicians.
authors.affiliation: Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle NE, Atlanta, GA 30322, USA. Electronic address: rfaught@emory.edu.
authors.forename: Edward
authors.initials: E
authors.lastname: Faught
authors.affiliation: Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle NE, Atlanta, GA 30322, USA. Electronic address: shelmer@emory.edu.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Helmers
authors.affiliation: Division of Management, Policy, and Community Health, The University of Texas - Houston School of Public Health, 1200 Hermann Pressler Street, E317, Houston, TX 77030, USA. Electronic address: Charles.E.Begley@uth.tmc.edu.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Begley
authors.affiliation: Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle NE, Atlanta, GA 30322, USA. Electronic address: djthurman1@gmail.com.
authors.forename: David J
authors.initials: DJ
authors.lastname: Thurman
authors.affiliation: UCB Pharma, 1950 Lake Park Dr SE, Smyrna, GA 30080, USA. Electronic address: Cynthia.Dilley@ucb.com.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Dilley
authors.affiliation: UCB Pharma, 1950 Lake Park Dr SE, Smyrna, GA 30080, USA. Electronic address: Chris.Clark@ucb.com.
authors.forename: Chris
authors.initials: C
authors.lastname: Clark
authors.affiliation: UCB Pharma, 1950 Lake Park Dr SE, Smyrna, GA 30080, USA. Electronic address: Patty.Fritz@ucb.com.
authors.forename: Patty
authors.initials: P
authors.lastname: Fritz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D016208:Databases, Factual / Q000639:trends*; D004827:Epilepsy / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D012189:Retrospective Studies; D012306:Risk; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Antiepileptic drugs; Claims database; Comorbidities; Epilepsy; Medical care; Switching