Claims Analysis of Healthcare Disparities Among Patients with Lennox-gastaut Syndrome or Dravet Syndrome in Urban versus Rural Areas of the United States
Abstract number :
3.473
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2024
Submission ID :
1385
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Satish Rao, MD, MS, MD, MS – Takeda Development Center Americas, Inc., Cambridge, MA, USA
Sudhakar Manne, MS – Takeda Pharmaceuticals USA, Inc.
Vivek Gandhi, MS – Takeda Pharmaceuticals USA, Inc.
Mei Lu, MD, MS – Takeda Development Center Americas, Inc., Cambridge, MA, USA
Rationale: Among patients with Lennox-Gastaut syndrome (LGS) or Dravet syndrome (DS), little evidence exists on the implications of living in urban vs rural areas. This claims analysis examined the impact of population area in patients with LGS or DS who had available insurance data.
Methods: Patients with LGS or DS were identified from Komodo’s Healthcare MapTM (2016-2023) closed claims data. Comorbidities, seizure and nonseizure symptoms, and healthcare resource utilization (HCRU) were compared between patients in urban vs rural settings during a randomly selected and continuously enrolled 12-month period, using regression models controlled for demographics. Areas were identified based on zip codes of patients’ healthcare providers using the Centers for Medicare & Medicaid Services urban/rural mapping method and validated with Komodo’s pharmacy database.
Results: Among the 9644 patients with LGS assessed, 88% lived in urban areas and 12% in rural areas; 848 patients with DS were assessed, with 85% from urban areas and 15% from rural areas. Median ages (years) were 15 (LGS) and 11 (DS). The Midwest region had the greatest difference between urban (LGS: 14%, DS: 19%) and rural patients (LGS: 26%, DS: 33%). Significantly more White patients lived in rural (LGS: 56%, DS: 56%) vs urban areas (LGS: 36%, DS: 37%). Compared with patients in urban areas (urban/rural), patients with LGS in rural areas were less likely to have diagnoses of a learning disability (45%/40%) or delayed motor skills (32%/30%) and more likely to have a diagnosis of ADHD (8%/12%) (Table 1). In patients with DS, no significant differences were noted in percentages of nonseizure symptoms in urban vs rural areas (Table 1). When epilepsy-related HCRU was assessed (Table 2), mean numbers of professional office visits were lower in rural areas vs urban areas (LGS: 15 [urban] vs 11 [rural]; DS: 24 [urban] vs 15 [rural]), as were mean numbers for home health and durable medical equipment (LGS: 25 [urban] vs 19 [rural]; DS: 30 [urban] vs 15 [rural]); the mean number of ER visits was higher in rural (0.9) vs urban (0.8) areas among patients with LGS. In patients with LGS, treatment with maintenance antiseizure medications (ASMs) was higher in rural vs urban areas (96% vs 93%); in patients with DS, it was higher in urban vs rural areas (99% vs 95%). Differences in treatment with brand ASMs or rescue ASMs were not noted.
Conclusions: Among patients with LGS or DS who had access to healthcare, those in urban and rural areas had comparable patterns of ASM usage. However, compared with patients in urban areas, those in rural areas were less likely to use routine care, such as professional office visits or home care. Patients with LGS in rural areas were more likely to visit the ER and less likely to be diagnosed with comorbidities and nonseizure symptoms. Clinicians and policy makers should be aware of care disparities across geographic areas.
Funding: Takeda Pharmaceuticals USA, Inc., Cambridge, MA, USA funded the study and writing support.
Health Services (Delivery of Care, Access to Care, Health Care Models)