PIH77 Annual Overall and Epilepsy-Related Health Care Utilization in Adult Epilepsy Patients in the United States

Abstract

There are multiple drug options for the treatment of epilepsy. Some patients may be refractory to treatment and require combination antiepileptic drug (AED) treatment. We compared healthcare utilization of refractory and stable epilepsy patients. Using a claims database covering 2007-2009, we identified adults (age≥18years) with epilepsy who were either stable on therapy (no change in AED over 12 months) or were refractory (defined as adding AED therapy to an existing regimen). An index date in 2008 was selected: the date on which an additional AED was started for refractory patients; and a convenience date for stable patients. All pharmacy and medical claims in the post-index year were used to estimate overall utilization. Claims with epilepsy in any diagnosis field were used to estimate epilepsy-related utilization. Logistic regression models were used to adjust for baseline differences. There were 1536 refractory and 8571 stable patients (age: 41.8 vs. 43years; 50.7% vs. 47.6% female; mean Charlson comorbidity index: 0.7 vs. 0.5). Refractory patients were hospitalized more often than stable patients, both for any diagnosis (18.3% vs. 9.8% had ≥1 hospitalization) and for epilepsy-related diagnoses (15.7% vs. 7%). Refractory patients had greater mean hospital length of stay (any diagnosis: 10.9 vs. 7.1 and epilepsy-related: 8.9 vs. 5.6 days). They also had more physician office visits than stable patients (any diagnosis: 12 vs. 9 and epilepsy-related: 3.6 vs. 2.2). After adjusting for demographics, region, usual-care physician specialty, and risk factors, the odds of hospitalization (OR:1.8; 95% CI:1.6-2.1), emergency department visit (OR:1.6; CI:1.5-1.8), epilepsy-related hospitalization (OR:2.2; CI:1.9-2.6), and epilepsy-related emergency department visit (OR:1.9; CI:1.7-2.2) were greater in the refractory group. Patients with refractory epilepsy use significantly more health care services than those with stable disease. As new and more effective AEDs become available, it may be possible to reduce utilization in the refractory group.