Mehta Darshan, Davis Matthew, Epstein Andrew J, Wensel Brian, Grinnell Todd, Williams G Rhys
Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.
Medicus Economics, LLC, Milton, MA, USA.
Clinicoecon Outcomes Res. 2021 Apr 19;13:251-261. doi: 10.2147/CEOR.S303079. eCollection 2021.
To examine the association between initiating first-line (1L) monotherapy with eslicarbazepine acetate (ESL) vs a generic antiseizure drug (ASD) and healthcare resource utilization (HCRU) and charges in adults with treated focal seizures (FS).
This was a retrospective analysis of Symphony Health's Integrated Dataverse open-source claims data. Two cohorts were identified as having initiated 1L monotherapy with ESL or literature-defined generic ASDs. Linear regression models with person fixed effects and inverse probability treatment weights assessed the relative additional changes in HCRU and charges among patients who received ESL compared to generic ASD.
A total of 250 and 43,220 patients initiated ESL (48.3 years; 57.2% female) or a generic ASD (54.5 years; 58.1% female), respectively. Compared to patients initiating a generic ASD, patients treated with ESL had additional reductions of 11.8 percentage points in the likelihood of any all-cause outpatient visits (<0.001), 7.4 percentage points in the likelihood of any emergency department (ED) visits (=0.013), and 22.7 percentage points in the likelihood of any FS-related outpatient visits (<0.001). Patients initiating ESL had greater reductions in mean charges for all-cause medical ($2620; =0.002), outpatient ($1995; =0.005), and non-FS-related medical ($2708; <0.001) services. Patients initiating ESL had greater relative increases in mean total prescription ($1368; <0.001) and ASD-related prescription ($1636; <0.001) charges, but greater relative reductions in non-ASD prescription ($269; =0.032) charges. The increases in prescription charges were of a lower magnitude than the decreases in medical charges.
Initiation of ESL as 1L monotherapy was associated with statistically significantly greater reductions in any use of several all-cause and FS-related services, number of visits, and charges compared to initiation of a generic ASD as 1L monotherapy in patients with FS. Initiation of a generic ASD as 1L monotherapy was associated with significantly smaller increases in total prescription charges and ASD-related prescription charges.
研究使用醋酸艾司利卡西平（ESL）作为一线（1L）单药治疗与使用普通抗癫痫药物（ASD）治疗相比，对伴有局灶性癫痫发作（FS）的成人患者医疗资源利用（HCRU）和费用的影响。
这是一项对Symphony Health综合数据集开源索赔数据的回顾性分析。确定了两个队列，分别为开始使用ESL或文献定义的普通ASD进行1L单药治疗的患者。采用具有个体固定效应和逆概率治疗权重的线性回归模型，评估接受ESL治疗的患者与接受普通ASD治疗的患者相比，HCRU和费用的相对额外变化。
共有250例和43220例患者分别开始使用ESL（年龄48.3岁；女性占57.2%）或普通ASD（年龄54.5岁；女性占58.1%）进行治疗。与开始使用普通ASD治疗的患者相比，接受ESL治疗的患者因任何原因进行门诊就诊的可能性额外降低了11.8个百分点（<0.001），因任何原因前往急诊科（ED）就诊的可能性降低了7.4个百分点（=0.013），因任何与FS相关的门诊就诊的可能性降低了22.7个百分点（<0.001）。开始使用ESL治疗的患者在全因医疗（2620美元；=0.002）、门诊（1995美元；=0.005）和非FS相关医疗（2708美元；<0.001）服务的平均费用方面有更大幅度的降低。开始使用ESL治疗的患者在总处方（1368美元；<0.001）和与ASD相关的处方（1636美元；<0.001）费用方面有更大幅度的相对增加，但在非ASD处方（269美元；=0.032）费用方面有更大幅度的相对降低。处方费用的增加幅度低于医疗费用的降低幅度。
与在FS患者中使用普通ASD作为1L单药治疗相比，使用ESL作为1L单药治疗在统计学上显著降低了多种全因和FS相关服务的使用、就诊次数和费用。使用普通ASD作为1L单药治疗与总处方费用和与ASD相关的处方费用的显著较小增加相关。
