From the Health Services Research Program (C.E.H., C.C.L., J.F.B., K.A.K., L.E.S., B.C.C.), Department of Neurology, University of Michigan, Ann Arbor; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and American Academy of Neurology (B.M.), Minneapolis, MN.
Neurology. 2019 Feb 26;92(9):e973-e987. doi: 10.1212/WNL.0000000000007004. Epub 2019 Jan 23.
To determine the association of a neurologist visit with health care use and cost outcomes for patients with incident epilepsy.
Using health care claims data for individuals insured by United Healthcare from 2001 to 2016, we identified patients with incident epilepsy. The population was defined by an epilepsy/convulsion diagnosis code (ICD codes 345.xx/780.3x, G40.xx/R56.xx), an antiepileptic prescription filled within the succeeding 2 years, and neither criterion met in the 2 preceding years. Cases were defined as patients who had a neurologist encounter for epilepsy within 1 year after an incident diagnosis; a control cohort was constructed with propensity score matching. Primary outcomes were emergency room (ER) visits and hospitalizations for epilepsy. Secondary outcomes included measures of cost (epilepsy related, not epilepsy related, and antiepileptic drugs) and care escalation (including EEG evaluation and epilepsy surgery).
After participant identification and propensity score matching, there were 3,400 cases and 3,400 controls. Epilepsy-related ER visits were more likely for cases than controls (year 1: 5.9% vs 2.3%, < 0.001), as were hospitalizations (year 1: 2.1% vs 0.7%, < 0.001). Total medical costs for epilepsy care, nonepilepsy care, and antiepileptic drugs were greater for cases ( ≤ 0.001). EEG evaluation and epilepsy surgery occurred more commonly for cases ( ≤ 0.001).
Patients with epilepsy who visited a neurologist had greater subsequent health care use, medical costs, and care escalation than controls. This comparison using administrative claims is plausibly confounded by case disease severity, as suggested by higher nonepilepsy care costs. Linking patient-centered outcomes to claims data may provide the clinical resolution to assess care value within a heterogeneous population.
确定神经科就诊与新发癫痫患者的医疗保健使用和成本结果之间的关联。
使用 2001 年至 2016 年期间 United Healthcare 承保的个人健康护理索赔数据，我们确定了新发癫痫患者。该人群的定义是癫痫/抽搐诊断代码（ICD 代码 345.xx/780.3x、G40.xx/R56.xx）、随后 2 年内开的抗癫痫处方以及前 2 年内均不符合上述标准。病例定义为在癫痫发作后 1 年内有神经科就诊的患者；采用倾向评分匹配构建对照组。主要结局是癫痫急诊就诊和住院。次要结局包括成本（癫痫相关、非癫痫相关和抗癫痫药物）和治疗升级（包括脑电图评估和癫痫手术）的措施。
在参与者识别和倾向评分匹配后，有 3400 例病例和 3400 例对照。癫痫相关急诊就诊的病例比对照更常见（第 1 年：5.9%比 2.3%，<0.001），住院也更常见（第 1 年：2.1%比 0.7%，<0.001）。癫痫护理、非癫痫护理和抗癫痫药物的总医疗费用病例更高（≤0.001）。更常见的病例进行脑电图评估和癫痫手术（≤0.001）。
就诊神经科的癫痫患者比对照有更多的后续医疗保健使用、医疗费用和治疗升级。这种使用行政索赔进行的比较可能受到病例疾病严重程度的混杂，因为非癫痫护理费用更高。将患者为中心的结局与索赔数据相关联，可能为评估异质人群中的护理价值提供临床分辨率。
