Earlier Use of Adjunctive Antiepileptic Drugs in Patients with Refractory Disease Could Reduce Costs

VBCN - July 2014 Volume 1, No 2

Philadelphia, PA—Changing from monotherapy to the early initiation of adjunctive therapy with a second antiepileptic drug in patients with partial-onset seizures may lead to a substantial reduction in healthcare utilization and costs, according to a retrospective claims database analysis presented in a poster at the 2014 American Academy of Neurology meeting.

Despite slightly higher pharmacy costs, total monthly and epilepsy-related costs were approximately 40% lower with early adjunctive therapy opposed to sequential monotherapy, according to Jason Zhixiao Wang, PhD, Health Economics and Outcomes Research, Eisai, Inc, and colleagues.

“Early identification and appropriate medical management of patients with potentially refractory epilepsy may help achieve earlier and improved seizure control and reduce overall healthcare costs,” noted Dr Wang.

The investigators noted that patients with epilepsy in whom initial antiepileptic drug monotherapy fails are often switched to another monotherapy, even though the likelihood of response to another monotherapy is less than it is with adjunctive therapy.

The researchers used administrative claims from the MarketScan Commercial and Medicare databases that includes approximately 32 million covered lives to evaluate the economic impact of moving from monotherapy to adjunctive therapy in patients with partial-onset seizures.

Patients with a diagnosis of partial-onset seizures who had at least 2 claims and received at least 2 prescriptions for an antiepileptic drug were initially identified. They were required to have at least 1 year of follow-up after the index date.

Overall, 15,007 patients with partial-onset seizures were identified from the database. Of these, 1349 (9%) patients had an antiepileptic drug treatment change from monotherapy to adjunctive therapy. All-cause and epilepsy-related resource utilization costs were evaluated.

Patients who were switched from monotherapy to adjunctive therapy had used monotherapy for an average of 269 days, and 51.3% of the patients used ≥2 sequential drugs as monotherapy before trying adjunctive therapy.

More patients were hospitalized during the monotherapy portion of their treatment compared with patients using adjunctive therapy (38% vs 28%, respectively; P <.001), and more patients using monotherapy were hospitalized for epilepsy-related reasons than those using adjunctive therapy (28% vs 19%, respectively; P <.001).

Emergency department visits were also more common among patients using monotherapy than adjunctive therapy for all-cause visits (50% vs 46%, respectively; P <.001) and epilepsy-related (30% vs 22%, respectively; P <.001).

The adjusted average epilepsy-related monthly costs (in 2009 dollars) were:
  • $1579 in the monotherapy period
  • $886 in the adjunctive therapy period.
All-cause costs were:
  • $4148 in the monotherapy period
  • $2855 during adjunctive therapy.

“Healthcare costs were consistently lower in the adjunctive therapy period than the monotherapy period” (P <.001) across all medical categories, including hospitalizations, emergency department visits, and outpatient visits, noted Dr Wang.

The average monthly pharmacy costs were slightly higher during the adjunctive therapy period. The medication costs were similar between the monotherapy and adjunctive therapy periods: the antiepileptic drug costs were $187 and $193, respectively, and the overall prescription costs were $543 and $518, respectively.

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