Fitch Kathryn, Pan Xiaoyun, Lau Jocelyn, Engel Tyler, Rajagopalan Krithika
Principal and Healthcare Consultant, Milliman, New York, NY.
employee of Sunovion during the study.
Am Health Drug Benefits. 2019 May;12(3):151-158.
Based on data from 2003 to 2007, the prevalence of epilepsy was significantly higher in the institutionalized elderly population than in the noninstitutionalized population, but the recent prevalence and economic impact of epilepsy specifically in the institutionalized Medicare population have not been reported.
To estimate the prevalence and economic burden of epilepsy and inpatient utilization rates among institutionalized Medicare beneficiaries and to provide a 10-year projection of their population size and the associated costs.
We performed a cross-sectional analysis of the institutionalized Medicare population with and without epilepsy using Medicare 5% sample claims data from 2013 and 2014. The identification of epilepsy required ≥1 qualifying claims with an epilepsy diagnosis, or ≥2 qualifying claims ≥30 days apart with a diagnosis of convulsion, in 2014. Institutionalized status was identified by having ≥6 consecutive months of nursing facility claims in 2013 or 2014. Inpatient admissions and 30-day readmissions, average allowed costs, and risk-adjusted incremental costs of epilepsy were calculated and compared between the institutionalized population of Medicare beneficiaries with and without epilepsy. The 2015 Medicare 100% and 5% sample data and inputs from other external sources were used to project the 10-year trends in the size and cost of the institutionalized Medicare population with epilepsy.
The prevalence of epilepsy in 2014 was 11.1% in the institutionalized Medicare population. The institutionalized population with epilepsy had significantly higher per-patient per-month (PPPM) costs ($3479 vs $2381, respectively; <.001), inpatient admissions per 1000 beneficiaries (1105 vs 697, respectively; <.001), and 30-day readmissions per 1000 beneficiaries (287 vs 145, respectively; <.001) versus the institutionalized population without epilepsy. The risk-adjusted incremental cost of epilepsy for the institutionalized population was $507.33 PPPM. Based on our model, between 2017 and 2027 an 18% increase in size and a 72% increase in cost are projected for the institutionalized Medicare beneficiaries with epilepsy.
The high cost and inpatient resource utilization, as well as the projected growth of the institutionalized Medicare population with epilepsy highlight the need for further investigation of care management opportunities to reduce the cost burden associated with this condition.
根据2003年至2007年的数据，癫痫在机构养老的老年人群中的患病率显著高于非机构养老人群，但癫痫在机构养老的医疗保险人群中的最新患病率和经济影响尚未见报道。
估计机构养老的医疗保险受益人中癫痫的患病率、经济负担和住院利用率，并对其人口规模及相关费用进行10年预测。
我们使用2013年和2014年医疗保险5%抽样理赔数据，对机构养老的有癫痫和无癫痫的医疗保险人群进行横断面分析。2014年，癫痫的认定要求有≥1条符合条件的癫痫诊断理赔记录，或≥2条间隔≥30天的惊厥诊断理赔记录。机构养老状态通过2013年或2014年连续≥6个月的护理机构理赔记录来确定。计算并比较了有癫痫和无癫痫的机构养老医疗保险受益人群的住院入院和30天再入院情况、平均允许费用以及癫痫的风险调整增量费用。利用2015年医疗保险100%和5%抽样数据以及其他外部来源的输入数据，对有癫痫的机构养老医疗保险人群的规模和费用的10年趋势进行预测。
在机构养老的医疗保险人群中，2014年癫痫患病率为11.1%。与无癫痫机构养老人群相比，有癫痫的机构养老人群的人均每月费用（分别为3479美元和2381美元；P<.001）、每1000名受益人住院入院次数（分别为1105次和697次；P<.001）以及每1000名受益人30天再入院次数（分别为287次和145次；P<.001）显著更高。机构养老人群中癫痫的风险调整增量费用为人均每月507.33美元。根据我们的模型，预计在2017年至2027年期间，有癫痫的机构养老医疗保险受益人的规模将增长18%，费用将增长72%。
癫痫的高成本和住院资源利用率，以及有癫痫的机构养老医疗保险人群预计的增长，凸显了进一步研究护理管理机会以减轻与该疾病相关的成本负担的必要性。
