Fishman Jesse, Kalilani Linda, Song Yan, Swallow Elyse, Wild Imane
1 UCB Pharma, Smyrna, Georgia.
2 UCB Pharma, Raleigh, North Carolina.
J Manag Care Spec Pharm. 2018 Sep;24(9):929-938. doi: 10.18553/jmcp.2018.17337. Epub 2018 Feb 27.
Unexpected breakthrough seizures resulting from suboptimal antiepileptic drug (AED) dosing during the titration period, as well as adverse events resulting from rapid AED titration, may influence the titration schedule and significantly increase health care resource use (HRU) and health care costs.
To assess the relationship between AEDs, HRU, and costs during AED titration and maintenance.
Practicing neurologists were recruited from a nationwide panel to provide up to 3 patient records each for this retrospective medical chart review. Patients with epilepsy who were aged ≥ 18 years and had initiated an AED between January 1, 2014, and January 1, 2016, were followed for 6 months from AED initiation. Titration duration was the time from AED initiation to the beginning of treatment maintenance as determined by the physician. Outcomes were epilepsy-specific HRU (hospitalizations, emergency department visits, outpatient visits, physician referral, laboratory testing/diagnostic imaging, and phone calls) and related costs that occurred during the titration or maintenance treatment periods.
Of 811 patients, 156, 128, 125, 120, 114, 107, and 61 initiated the following AEDs: levetiracetam, lamotrigine, lacosamide, valproate, topiramate, carbamazepine, and phenytoin, respectively. Most patients (619/803 [77.1%] with complete AED data) received monotherapy. Baseline characteristics were similar across AEDs (mean [SD] age, 36.6 [14.4] years; 59.0% male). Kaplan-Meier estimates of titration duration ranged from 3.3 weeks (phenytoin) to 8.1 weeks (lamotrigine). From titration to maintenance, the overall incidence of HRU per person-month decreased 54.5%-89.3% for each HRU measure except outpatient visits (24.6% decrease). Total epilepsy-related costs decreased from $80.48 to $42.77 per person-month, or 46.9% from titration to maintenance.
AED titration periods had higher HRU rates and costs than AED maintenance, suggesting that use of AEDs with shorter titration requirements reduces health care costs, although disease severity may also factor into overall cost.
UCB Pharma sponsored this study and reviewed the manuscript. Fishman and Kalilani are employees of UCB Pharma. Wild was an employee of UCB Pharma at the time this analysis was conducted. Song and Swallow are employees of Analysis Group, which received funding from UCB Pharma.
在滴定期抗癫痫药物（AED）剂量未达最佳导致意外的突破性癫痫发作，以及AED快速滴定导致的不良事件，可能会影响滴定计划，并显著增加医疗资源使用（HRU）和医疗成本。
评估AED滴定和维持期间AED、HRU和成本之间的关系。
从全国性专家小组中招募执业神经科医生，每位医生提供多达3份患者记录用于此次回顾性病历审查。年龄≥18岁且在2014年1月1日至2016年1月1日期间开始使用AED的癫痫患者，从开始使用AED起随访6个月。滴定持续时间是指从开始使用AED到医生确定的治疗维持开始的时间。结局指标为癫痫特异性HRU（住院、急诊就诊、门诊就诊、医生转诊、实验室检查/诊断成像和电话咨询）以及滴定或维持治疗期间发生的相关成本。
811例患者中，分别有156例、128例、125例、120例、114例、107例和61例开始使用以下AED：左乙拉西坦、拉莫三嗪、拉科酰胺、丙戊酸盐、托吡酯、卡马西平和苯妥英。大多数患者（619/803 [77.1%]有完整的AED数据）接受单药治疗。各AED的基线特征相似（平均[标准差]年龄，36.6 [14.4]岁；男性占59.0%）。Kaplan-Meier估计的滴定持续时间从3.3周（苯妥英）到8.1周（拉莫三嗪）不等。从滴定到维持，除门诊就诊（下降24.6%）外，每人每月的HRU总体发生率每项指标下降了54.5%-89.3%。癫痫相关总成本从每人每月80.48美元降至42.77美元，从滴定到维持下降了46.9%。
AED滴定期的HRU率和成本高于AED维持期，这表明使用滴定要求较短的AED可降低医疗成本，尽管疾病严重程度也可能是总体成本的一个因素。
优时比制药公司赞助了这项研究并审阅了手稿。Fishman和Kalilani是优时比制药公司的员工。Wild在进行此次分析时是优时比制药公司的员工。Song和Swallow是Analysis Group的员工，该公司接受了优时比制药公司的资助
