Newer antiepileptic drug use and other factors decreasing hospital encounters

• Published in: Epilepsy & behavior 2015-04, Vol.45, p.169-175
• Main Authors: Faught, Edward, Helmers, Sandra L, Begley, Charles E, Thurman, David J, Dilley, Cynthia, Clark, Chris, Fritz, Patty
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anticonvulsants - therapeutic use; Antiepileptic drugs; Child; Claims database; Comorbidities; Databases, Factual - trends; Epilepsy; Epilepsy - diagnosis; Epilepsy - drug therapy; Epilepsy - epidemiology; Female; Hospitalization - trends; Humans; Male; Medical care; Middle Aged; Neurology; Physician's Role; Retrospective Studies; Risk; Switching; Young Adult
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2015.01.039

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 684 days, while those taking ≥ 1 second-generation AED were hospitalized every 1001 days (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.