Patterns of utilization and cost of healthcare services and pharmacotherapy among patients with drug-resistant epilepsy during the two-year period before neurostimulation: A descriptive analysis of the journey to implantation based on analyses of a large United States healthcare claims database

• Published in: Epilepsy & behavior Vol. 145; p. 109288
• Main Authors: Evans, Kathryn, Stamas, Nicole, Li, Qian, Vincent, Tom, Zhang, Lu, Danielson, Vanessa, Lam, Sandi, Lassagne, Reginald, Berger, Ariel
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2023
• Subjects: Administrative Claims, Healthcare; Cost of Illness; Delivery of Health Care; Drug Resistant Epilepsy - epidemiology; Drug Resistant Epilepsy - therapy; Drug-Resistant Epilepsy; Epilepsy - drug therapy; Epilepsy - therapy; Health Care Costs; Health resources; Health Services; Humans; Implantable Neurostimulators; Quality of Life; Retrospective Studies; United States - epidemiology; United States; Cost of Illness; Health resources; Administrative Claims, Healthcare; Implantable Neurostimulators; Drug-Resistant Epilepsy
• DOI: 10.1016/j.yebeh.2023.109288
• ISSN: 1525-5050

•About 30% of patients with DRE awaiting implantation have depression and/or anxiety.•Most (59%) patients with DRE are hospitalized within 2 years prior to implantation.•DRE patients average 20.2 physicians visits in the 2-year pre-implantation period.•42.7% of patients were dispensed at least five unique ASMs during pre-implantation.•Mean all-cause healthcare costs were $123,500, of which 75% were epilepsy-related. To conduct a descriptive assessment of patterns of utilization and cost of healthcare services and pharmacotherapies among patients with drug-resistant epilepsy (DRE) before neurostimulator implantation. Using a large United States healthcare claims database, we identified all patients with DRE who were implanted with neurostimulators between January 1, 2012, and December 31, 2019. Patients without an epilepsy diagnosis on their implantation date were excluded, as were those without (1) anti-seizure medication (ASM) dispenses within 12 months of implantation date, and (2) continuous enrollment for the 24-month period before this date. Demographic and clinical characteristics were assessed over the two-year period before implantation, as were patterns of utilization and cost of healthcare services and pharmacotherapy. Care was assessed as all-cause or epilepsy-related, with the latter defined as all medical (inpatient and outpatient) care resulting in diagnoses of epilepsy and all ASM dispenses. Eight hundred sixty patients met all selection criteria. Among these patients, comorbidities were common, including depression (27%), anxiety (30%), and learning disabilities (25%). Fifty-nine percent of patients had ≥1 all-cause hospitalizations; 57% had ≥1 epilepsy-related admissions. Patients averaged 8.6 epilepsy-related visits to physicians’ offices, including 5.1 neurologist visits. Mean all-cause and epilepsy-related healthcare costs during the pre-implantation period were $123,500 and $91,995, respectively; corresponding median values were $74,567 and $53,029. Median monthly all-cause healthcare costs increased by 138% during the 24-month period (from $1,042 to $2,481 in the month prior to implantation); median epilepsy-related costs, by 290% (from $383 to $1,492). The two-year period before neurostimulator implantation is a long and costly journey. Estimates likely minimize the burden experienced during this period, given that seizure frequency and severity—and corresponding impacts on quality of life—were unavailable in these data. Further research is needed to understand the clinical, economic, and psychological impact of the time between DRE onset and implantation among qualifying patients.