Evans Kathryn, Li Qian, Zhang Lu, Lam Sandi, Do Rego Bronwyn, Danielson Vanessa, Lassagne Reginald, Berger Ariel
Thermo Fisher Scientific, Waltham, MA, USA.
Department of Neurosurgery, Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Clinicoecon Outcomes Res. 2025 Aug 28;17:571-583. doi: 10.2147/CEOR.S551202. eCollection 2025.
Current treatment guidelines recommend consideration of neurostimulators and other alternative treatments to antiseizure medications in patients with drug-resistant epilepsy (DRE). This study assessed patterns of utilization and cost of healthcare services and prescription pharmacotherapies during the 2-year period before neurostimulator implantation among Medicaid enrollees with DRE.
This retrospective, observational cohort study used healthcare claims and enrollment data obtained from the US Centers for Medicare and Medicaid Services. Medicaid enrollees who met study selection criteria (ie, evidence of DRE and neurostimulator implantation) between January 1, 2011, and December 31, 2020, were included. Those without antiseizure medication (ASM) dispenses within 12 months of their implantation date or continuous enrollment for the 24-month period before this date were excluded. Demographic/clinical characteristics, utilization and cost of healthcare services, and prescription pharmacotherapies were assessed over the 2-year period before implantation. Care was designated as all-cause or epilepsy-related; the latter was defined as all ASM dispenses and all claims for medical care (ie, inpatient or outpatient) with a diagnosis code (any position) of epilepsy.
In total, 2469 patients met the selection criteria. Mean age at implantation was 20.8 years. Comorbidities were common. Over the 2-year period before implantation, patients were prescribed a mean of 4.4 unique ASMs. Fifty-seven percent had at least one all-cause hospital admission, and 82.9% had at least one all-cause emergency department visit; corresponding epilepsy-related values were 55.3% and 66.1%. Less than half of patients received specific cranial imaging, including video electroencephalographs. Total mean all-cause healthcare costs were $117,013; epilepsy-related healthcare costs accounted for $48,169 (41.2%).
Medicaid enrollees with DRE experience high use and cost of healthcare services and pharmacotherapy over the 2 years before neurostimulator implantation. Further research is needed to understand the impacts associated with broader access to specialized epilepsy care, such as cranial imaging and neurostimulators.
当前的治疗指南建议，对于耐药性癫痫（DRE）患者，应考虑使用神经刺激器和其他替代抗癫痫药物的治疗方法。本研究评估了DRE的医疗补助参保者在植入神经刺激器前2年期间的医疗服务利用模式和成本以及处方药物治疗情况。
这项回顾性观察队列研究使用了从美国医疗保险和医疗补助服务中心获得的医疗理赔和参保数据。纳入了2011年1月1日至2020年12月31日期间符合研究选择标准（即有DRE和神经刺激器植入证据）的医疗补助参保者。排除在植入日期前12个月内未使用抗癫痫药物（ASM）或在此日期前24个月内未持续参保的患者。在植入前的2年期间评估人口统计学/临床特征、医疗服务利用和成本以及处方药物治疗情况。医疗护理分为全因性或癫痫相关性；后者定义为所有ASM配药以及所有诊断代码（任何位置）为癫痫的医疗护理（即住院或门诊）理赔。
共有2469名患者符合选择标准。植入时的平均年龄为20.8岁。合并症很常见。在植入前的2年期间，患者平均被处方4.4种不同的ASM。57%的患者至少有一次全因性住院，82.9%的患者至少有一次全因性急诊就诊；相应的癫痫相关性数值分别为55.3%和66.1%。不到一半的患者接受了特定的头颅影像学检查，包括视频脑电图检查。全因性医疗总平均成本为117,013美元；癫痫相关性医疗成本为48,169美元（41.2%）。
DRE的医疗补助参保者在植入神经刺激器前2年期间医疗服务和药物治疗的使用及成本较高。需要进一步研究以了解更广泛获得专业癫痫护理（如头颅影像学检查和神经刺激器）的相关影响。
