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Epilepsy Behav. 2020 Nov;112:107426. doi: 10.1016/j.yebeh.2020.107426. Epub 2020 Sep 19.
Clinical research has consistently established mental health conditions (MHCs) as frequent comorbidities of epilepsy. However, the extent of economic burden of comorbid MHC in patients with focal seizures has not been systematically investigated. This retrospective cohort analysis of health plan claims compared healthcare use and costs among adult patients with focal seizures with and without comorbid MHC.
We utilized the Inovalon Medical Outcomes Research for Effectiveness and Economics (MORE) Registry, longitudinal data from over 150 commercial, Medicare Advantage, and managed Medicaid health plans for the analysis, and identified a cohort of patients with focal (partial-onset) seizure with relevant ICD9/10 diagnosis codes with and without MHC. Mental health conditions were defined as diagnoses for anxiety, bipolar condition/mania, attention-deficit conduct condition, major depression, schizophrenia, and other psychotic conditions, and patients without MHC were propensity score-matched to patients with preexisting MHC on baseline patient characteristics. The assessment examined a series of outcomes, including 1) direct healthcare resource utilization and 2) total provider reimbursement.
Patients with preexisting MHC were more likely to receive adjunctive epilepsy therapy as well as broad-spectrum antiepileptic drugs/antiseizure medications (ASMs). Additionally, patients with focal seizures and MHC were significantly more likely to utilize high-cost healthcare services. The presence of MHC was associated with approximately 50% greater utilization of emergency department (ED), physician, and inpatient services. Consequently, healthcare expenditures were significantly higher among patients with MHC ($17,596 vs. $10,857; 62% higher, p < 0.001), with the trend consistent across all care settings.
This analysis illustrates the health service utilization and cost implications of MHC among patients with focal seizures. The data suggest that patients with MHC have a greater overall clinical burden, which may be associated with higher healthcare resource use and expenditures. Because of the potential burden and costs associated with MHC, neurologists should consider screening patients with focal seizures for mental health disorders to identify and initiate treatment for comorbid mental health disorders.
临床研究一致表明，心理健康状况（MHCs）是癫痫的常见合并症。然而，局灶性发作患者合并 MHC 的经济负担程度尚未系统研究。本回顾性队列分析利用健康计划索赔数据，比较了合并和不合并 MHC 的局灶性发作成年患者的医疗保健使用和费用。
我们利用 Inovalon 医疗成果研究与经济学（MORE）登记处，对来自 150 多个商业、医疗保险优势计划和管理式医疗补助健康计划的纵向数据进行了分析，并确定了一个局灶性（部分发作）癫痫伴有相关 ICD9/10 诊断代码的患者队列，无论是否存在 MHC。心理健康状况定义为焦虑、双相情感障碍/躁狂症、注意力缺陷多动障碍、重度抑郁症、精神分裂症和其他精神病性疾病的诊断，没有 MHC 的患者根据基线患者特征与存在 MHC 的患者进行倾向评分匹配。评估检查了一系列结果，包括 1）直接医疗资源利用和 2）总提供者报销。
患有 MHC 的患者更有可能接受辅助癫痫治疗以及广谱抗癫痫药物/抗癫痫药物（ASMs）。此外，患有局灶性癫痫和 MHC 的患者更有可能使用高成本的医疗服务。存在 MHC 与急诊室（ED）、医生和住院服务的利用率增加约 50%相关。因此，MHC 患者的医疗保健支出明显更高（$17596 比 $10857；高 62%，p<0.001），所有护理环境均存在此趋势。
本分析说明了 MHC 对局灶性癫痫患者的卫生服务利用和成本的影响。数据表明，患有 MHC 的患者整体临床负担更大，这可能与更高的医疗资源利用和支出有关。由于 MHC 相关的潜在负担和成本，神经科医生应考虑对局灶性癫痫患者进行心理健康障碍筛查，以识别和治疗合并的心理健康障碍。
