Ettinger Alan B, Manjunath Ranjani, Candrilli Sean D, Davis Keith L
North Shore-Long Island Jewish Comprehensive Epilepsy Centers, EEG Lab LIJMC, New Hyde Park, NY 11040, USA.
Epilepsy Behav. 2009 Feb;14(2):324-9. doi: 10.1016/j.yebeh.2008.10.021. Epub 2008 Nov 24.
Retrospective insurance claims from the United States were analyzed to assess nonadherence to antiepileptic drugs (AEDs) and the association between AED nonadherence, seizures, and health care costs in elderly persons with epilepsy. Inclusion criteria were: age 65, epilepsy diagnosis between 1 January 2000 and 31 June 2006, 2 AED prescriptions, and insurance enrollment for 6 months pre- and 12 months post-AED initiation. Adherence was evaluated using the medication possession ratio (MPR), with MPR<0.8 defining nonadherence. Per-patient outcomes were evaluated over 12 months post-AED initiation. Of 1278 patients identified, 41% were nonadherent. Seizure, defined by epilepsy-related inpatient or emergency department admission, occurred in 12.1% of nonadherers versus 8.2% of adherers (P=0.0212). Nonadherers had higher inpatient (+$872, P=0.001), emergency department (+$143, P=0.0008), other outpatient ancillary (+$1741, P=0.0081), and total health care (+$2674, P=0.0059) costs. AED adherence among elderly patients with epilepsy is suboptimal and associated with increased seizures and health care costs.
分析了来自美国的回顾性保险理赔数据，以评估老年癫痫患者对抗癫痫药物（AED）的依从性以及AED不依从性、癫痫发作和医疗费用之间的关联。纳入标准为：年龄≥65岁，2000年1月1日至2006年6月31日期间确诊为癫痫，有2次AED处方，且在AED开始使用前6个月和开始使用后12个月参保。使用药物持有率（MPR）评估依从性，MPR<0.8定义为不依从。在AED开始使用后的12个月内评估每位患者的结局。在确定的1278例患者中，41%不依从。癫痫发作定义为因癫痫相关原因住院或急诊科就诊，12.1%的不依从者发生癫痫发作，而依从者为8.2%（P=0.0212）。不依从者的住院费用（+$872，P=0.001）、急诊科费用（+$143，P=0.0008）、其他门诊辅助费用（+$1741，P=0.0081）和总医疗费用（+$2674，P=0.0059）更高。老年癫痫患者的AED依从性欠佳，且与癫痫发作增加和医疗费用增加相关。
