Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, USA.
UCB Pharma, 1950 Lake Park Drive SE, Smyrna, GA 30080, USA.
Health Policy. 2018 Jul;122(7):797-802. doi: 10.1016/j.healthpol.2018.05.012. Epub 2018 May 26.
Epilepsy has a relatively high prevalence, and diagnosis and treatment are often challenging. Seizure freedom without significant side effects is the ultimate goal for both physicians and patients, but not always achievable. In those cases, the treatment goals of patients and providers may differ. In the United States, many clinicians continue to prescribe older AEDs, even though newer AEDs have a more desirable safety and tolerability profile, fewer drug-drug interactions, and are associated with lower epilepsy-related hospital visits. Newer AEDs are more commonly prescribed by neurologists and epilepsy center physicians, highlighting the importance of access to specialty care. We report that antiepileptic drugs are not the dominant cost driver for patients with epilepsy and costs are considerably higher in patients with uncontrolled epilepsy. Poor drug adherence is considered a main cause of unsuccessful epilepsy treatment and is associated with increases in inpatient and emergency department admissions and related costs. Interventions and educational programs are needed to address the reasons for nonadherence. Coverage policies placing a higher cost burden on patients with epilepsy lead to lower treatment adherence, which can result in higher future health care spending. Epilepsy is lagging behind other neurological conditions in terms of funding and treatment innovation. Increased investment in epilepsy research may be particularly beneficial given current funding levels and the high prevalence of epilepsy.
癫痫的发病率相对较高，其诊断和治疗往往具有挑战性。对于医生和患者来说，达到无明显副作用且无发作的治疗目标是最终目标，但并非总是能够实现。在这种情况下，患者和提供者的治疗目标可能存在差异。在美国，许多临床医生仍然开处方使用较老的抗癫痫药物，尽管较新的抗癫痫药物具有更理想的安全性和耐受性、较少的药物相互作用，并且与较低的癫痫相关住院就诊率相关。神经科医生和癫痫中心的医生更常开新型抗癫痫药物，这突出了获得专科护理的重要性。我们报告称，抗癫痫药物并不是癫痫患者的主要费用驱动因素，而未得到控制的癫痫患者的费用要高得多。药物依从性差被认为是癫痫治疗失败的主要原因，并且与住院和急诊就诊次数增加以及相关费用增加有关。需要采取干预措施和教育计划来解决不依从的原因。将更高的费用负担转嫁给癫痫患者的覆盖政策会导致治疗依从性降低，从而导致未来更高的医疗保健支出。在资金投入和治疗创新方面，癫痫落后于其他神经疾病。鉴于目前的资金水平和癫痫的高发病率，增加对癫痫研究的投资可能特别有益。
