Analysis Group, Inc., Los Angeles, CA, USA.
Greenwich Biosciences, Inc., Carlsbad, CA, USA.
Epilepsy Behav. 2020 Nov;112:107494. doi: 10.1016/j.yebeh.2020.107494. Epub 2020 Oct 5.
Data on the economic burden associated with tuberous sclerosis complex (TSC) among patients with epilepsy in the United States (US) are limited. This study aimed to assess all-cause and epilepsy-related healthcare resource utilization (HRU) and healthcare costs in the US among patients with epilepsy and TSC compared with patients with epilepsy but without TSC.
This retrospective study was conducted using the Symphony Health Solutions claims database (April 1, 2017-June 30, 2019). Patients with ≥1 medical claim with a diagnosis code representing epilepsy or seizures were assigned to the cohort with TSC if they had ≥1 medical claim for TSC; the remaining patients were assigned to the cohort without TSC. Patients in the cohort with TSC were exactly matched 1:5 on demographics to patients in the cohort without TSC. All-cause and epilepsy-related HRU, medical charges, prescription drug costs, and the use of antiepileptic drugs (AEDs) were compared between the matched cohorts over the 1-year study period.
A total of 2028 patients with epilepsy and TSC were matched to 10,140 patients with epilepsy but without TSC. Patients with TSC were more likely to have a diagnosis code for refractory epilepsy (38.7% vs. 10.2%, p < 0.001) and more likely to have used an AED (89.5% vs. 71.2%, p < 0.001) than patients without TSC over the study period. On average, patients with TSC received 2.1 distinct AEDs versus 1.3 distinct AEDs among patients without TSC. Compared with patients without TSC, patients with TSC had numerically but not statistically higher incidence rates of all-cause outpatient, clinic, office, and other visits; significantly lower rates of all-cause inpatient and emergency room visits (p < 0.001); and statistically significantly higher incidence rates of epilepsy-related outpatient, inpatient, office, and other visits (p ≤ 0.001). All-cause prescription drug costs were significantly higher among patients with TSC than patients without TSC (cost difference per patient: $14,179, p < 0.001). All-cause medical service charges were numerically higher for patients with TSC, but the differences were not statistically significant (charge difference per patient: $4293 for medical services, p = 0.707). Epilepsy-related costs were significantly higher for patients with TSC; the cost difference per patient was $14,639 for prescription costs (p < 0.001), and the charge difference per patient was $16,838 for medical charges (p = 0.019).
The results of this study underscore the high epilepsy-related HRU and costs incurred by patients with epilepsy and TSC relative to those incurred by patients with epilepsy but without TSC.
美国（美国）患有癫痫症患者中与结节性硬化症（TSC）相关的经济负担的数据有限。本研究旨在评估与无 TSC 的癫痫患者相比，患有癫痫症和 TSC 的患者的全因和癫痫相关医疗资源利用（HRU）和医疗保健费用。
本回顾性研究使用 Symphony Health Solutions 索赔数据库（2017 年 4 月 1 日至 2019 年 6 月 30 日）进行。≥1 项医疗索赔中具有代表癫痫或癫痫发作的诊断代码的患者，如果他们具有≥1 项代表 TSC 的医疗索赔，则被分配到 TSC 队列中；其余患者被分配到无 TSC 队列。在研究期间，TSC 队列中的患者与无 TSC 队列中的患者在人口统计学上精确匹配 1：5。比较了两组患者在 1 年研究期间的全因和癫痫相关 HRU、医疗费用、处方药费用和抗癫痫药物（AED）的使用情况。
共有 2028 名患有 TSC 的癫痫患者与 10140 名患有癫痫但无 TSC 的患者相匹配。与无 TSC 的患者相比，TSC 患者更有可能有难治性癫痫的诊断代码（38.7%比 10.2%，p<0.001），并且在研究期间更有可能使用 AED（89.5%比 71.2%，p<0.001）。平均而言，TSC 患者接受了 2.1 种不同的 AED，而无 TSC 患者接受了 1.3 种不同的 AED。与无 TSC 的患者相比，TSC 患者的全因门诊、诊所、办公室和其他就诊的发生率呈数值增加，但全因住院和急诊就诊的发生率较低（p<0.001）；癫痫相关门诊、住院、办公室和其他就诊的发生率呈统计学显著增加（p≤0.001）。与无 TSC 的患者相比，TSC 患者的全因处方药费用显著更高（每位患者的费用差异：14179 美元，p<0.001）。TSC 患者的全因医疗服务费用呈数值增加，但差异无统计学意义（每位患者的费用差异：医疗服务 4293 美元，p=0.707）。TSC 患者的癫痫相关费用明显更高；每位患者的处方费用差异为 14639 美元（p<0.001），每位患者的医疗费用差异为 16838 美元（p=0.019）。
这项研究的结果强调了患有癫痫症和 TSC 的患者相对于患有癫痫症但无 TSC 的患者所产生的高癫痫相关 HRU 和费用。
