Ascension Wisconsin, St. Mary's Hospital, 2301 N Lake Drive, Milwaukee, WI 53211 USA.
UCB Pharma, 1950 Lake Park Dr, Smyrna, GA, USA.
Epilepsy Behav. 2024 Aug;157:109867. doi: 10.1016/j.yebeh.2024.109867. Epub 2024 Jun 1.
Seizure clusters are underresearched and associated with adverse outcomes in patients with epilepsy. This study was a noninterventional, retrospective claims-based analysis using the Wisconsin Health Information Organization (WHIO) All-Payer Claims Database to characterize the epilepsy population in Wisconsin, with a focus on prevalence, treatment patterns, and healthcare resource utilization (HCRU) in patients with seizure clusters prior to the introduction of nasal spray rescue medications. This timeframe allows characterization of a historical baseline for future comparisons with newer treatments.
Four cohorts were defined: (1) all-epilepsy (all patients with epilepsy); and subcohorts of: (2) patients receiving a monotherapy antiseizure medication (ASM); (3) patients receiving ASM polytherapy; and (4) patients treated for seizure clusters (ie, those taking rescue medications and ≥ 1 ASM). Primary outcomes were HCRU over a 12-month follow-up period, which were descriptively analyzed.
Between 2017 and 2019, 16,384 patients were included in the all-epilepsy cohort; 11,688 (71.3 %) were on monotherapy, 3,849 (23.5 %) were on polytherapy, and 526 (3.2 %) were treated for seizure clusters. Twelve-month retentions to the ASM treatments were 46.7 % (7,895/16,904) in the all-epilepsy cohort, and 40.0 % (4,679/11,688) and 40.1 % (1,544/3,849) in the monotherapy and polytherapy subcohorts, respectively. Rescue medication prescriptions were obtained 1,029 times by the 526 patients in the treated seizure cluster subcohort, with infrequent refill rates (mean 1.6-1.9 times/year). A higher proportion of patients in the treated seizure cluster subcohort had epilepsy-related outpatient visits (89.7 %), other visits (71.3 %), and hospitalizations (25.3 %) than patients in the monotherapy (72.2 %, 50.2 %, 19.3 %, respectively) and polytherapy (83.3 %, 63.3 %, 22.8 %, respectively) subcohorts. Mean (standard deviation) all-cause ($114,717 [$231,667]) and epilepsy-related ($76,134 [$204,930]) costs over 12 months were higher in the treated seizure cluster subcohort than the monotherapy ($89,324 [$220,181] and $30,745 [$145,977], respectively) and polytherapy ($101,506 [$152,931] and $49,383 [$96,285], respectively) subcohorts.
Patients treated for seizure clusters incurred higher all-cause and epilepsy-related costs and epilepsy-related HCRU than other subcohorts and had infrequent rescue medication refills. The findings of this analysis highlight the need for appropriate treatment for those patients with epilepsy experiencing seizure clusters. The effect of newer rescue medications to alter these findings will be explored in a follow-up study. Regardless, specialist providers with expertise in treating refractory epilepsy and seizure cluster patients may help to reduce the burden of seizure clusters.
癫痫患者的癫痫发作群研究不足，且与不良结局相关。本研究是一项非干预性、回顾性的基于索赔的分析，使用威斯康星州健康信息组织（WHIO）全支付者索赔数据库，重点描述威斯康星州癫痫患者的人群特征，包括患病率、治疗模式以及癫痫发作群患者在引入鼻喷救援药物之前的医疗保健资源利用（HCRU）。这一时间框架允许对历史基线进行特征描述，以便与新的治疗方法进行未来比较。
定义了四个队列：（1）所有癫痫（所有癫痫患者）；以及亚队列：（2）接受单药抗癫痫药物（ASM）治疗的患者；（3）接受 ASM 联合治疗的患者；（4）治疗癫痫发作群的患者（即服用救援药物和≥1 种 ASM 的患者）。主要结果是 12 个月随访期间的 HCRU，对其进行描述性分析。
在 2017 年至 2019 年期间，共有 16384 名患者纳入所有癫痫队列；11688 名（71.3%）患者接受单药治疗，3849 名（23.5%）患者接受联合治疗，526 名（3.2%）患者治疗癫痫发作群。所有癫痫患者队列中，ASM 治疗的 12 个月保留率为 46.7%（7895/16904），单药和联合治疗亚队列的保留率分别为 40.0%（4679/11688）和 40.1%（1544/3849）。在接受治疗的癫痫发作群亚队列的 526 名患者中，共开具了 1029 次救援药物处方，且 refill 率较低（平均 1.6-1.9 次/年）。与单药（72.2%、50.2%、19.3%，分别）和联合治疗（83.3%、63.3%、22.8%，分别）亚队列相比，接受治疗的癫痫发作群亚队列中有更多的患者进行癫痫相关门诊就诊（89.7%）、其他就诊（71.3%）和住院治疗（25.3%）。在 12 个月内，所有原因（$114717 [231667]）和癫痫相关（$76134 [204930]）费用在治疗癫痫发作群亚队列中均高于单药（$89324 [220181]和$30745 [145977]，分别）和联合治疗亚队列（$101506 [152931]和$49383 [96285]，分别）。
治疗癫痫发作群的患者的全因和癫痫相关费用以及癫痫相关 HCRU 均高于其他亚队列，且救援药物 refill 频率较低。本分析结果强调了需要为那些经历癫痫发作群的癫痫患者提供适当的治疗。后续研究将探讨新的救援药物对改变这些发现的影响。无论如何，具有治疗难治性癫痫和癫痫发作群患者专业知识的专家提供者可能有助于减轻癫痫发作群的负担。
