WASHINGTON – People with epilepsy who were considered to be in intermediate control of their seizures were hospitalized for similar lengths of time and went to the emergency room as often as those with uncontrolled epilepsy in a large retrospective study of commercially insured adults with epilepsy, Dr. Fulton Velez reported at the annual meeting of the American Epilepsy Society.
The results suggest that the use of health care resources may be greater among patients whose seizures are less than optimally controlled, which "may have important health care utilization implications for patients and payers," said Dr. Velez, director of health economics and outcomes research at Sunovion Pharmaceuticals, a manufacturer of antiepileptic drugs (AEDs).
The investigators reviewed the use of health care resources in 26,625 adults with epilepsy who were enrolled in the MarketScan database, a national database that contains data on over 180 million patients since 1995, according to its website. The patients were treated with at least one add-on AED within 60 days of being diagnosed and were followed for at least 1 year (the average follow-up time was 3.25 years).
Dr. Velez and his colleagues fit the patients into three categories:
• Uncontrolled, defined as one emergency room or inpatient stay preceded by two or more changes in drug therapy, either an additional drug or a switch in drugs in the preceding 6 months.
• Well controlled, meaning no change in AED therapy and no epilepsy-related emergency room or inpatient visits.
• Intermediate controlled, which meant that the patient was not classified as uncontrolled or well controlled.
Most (83%) fell into the intermediate-control category, 2% were uncontrolled, and 15% were well controlled. Their mean age was 49 years and almost 60% were women.
As expected, the use of health care resources was markedly higher among the uncontrolled patients, Dr. Velez said. Patients in the uncontrolled category used significantly more AEDs and had significantly more outpatient and neurologist visits than did those in the well-controlled and intermediate-control categories.
The uncontrolled patients used 1.6 times more AEDs than did those who were well controlled and those who were in the intermediate-control category. The rate of outpatient visits was 20% higher among uncontrolled patients than in those who were well controlled. In addition, the rate of neurologist visits among those who were uncontrolled was about 40% higher than in those who were well controlled and 19% higher than those who were in the intermediate-control category, Dr. Velez said.
Not surprisingly, patients with uncontrolled epilepsy visited the emergency room 12 times as often and stayed in the hospital more than 7 times as often as did those with well-controlled epilepsy. Their duration of hospitalizations also was nine times as long.
There were, however, no differences in the rate of emergency room visits or length of hospital stays between the intermediate control and uncontrolled patients, Dr. Velez said. In addition, the rate of inpatient hospitalizations was about 12% higher among the intermediate-control group. "The findings of this study suggest that even small departures from optimal seizure control are associated with a marked increase in health resource utilization among epilepsy patients," he said in a statement issued by the American Epilepsy Society during the meeting.
The study was performed by HERON Evidence Development AB, Stockholm, and the data analysis was funded by Sunovion.