Abstracts

Use of antiepileptic drug (AED) monotherapy to achieve seizure control is a desirable goal in epilepsy management. AED monotherapy may diminish the exposure risk of drug-drug interactions resulting in decreased healthcare utilization and costs of epileptic patients. Levetiracetam (LEV) is an effective, well-tolerated, novel AED indicated for use as adjunctive therapy in partial onset seizures in adults with epilepsy. There has been interest in using LEV as monotherapy for epilepsy. Clinical studies are ongoing to ascertain LEVs[apos] efficacy and safety. The objective of this study was to compare, in a claims database, healthcare utilization and costs between LEV and a classical first generation AED, phenytoin (PHT), when prescribed as monotherapy to epileptic patients. Analyses were conducted using a large US medical and pharmaceutical claims database. Patients diagnosed with epilepsy newly started on PHT or LEV monotherapy between July 2001 and December 2003 were selected. A 6-month baseline period with no claim for PHT or LEV and a minimum 3-month follow-up were required. PHT patients were matched on a 1:1 basis to LEV patients with similar characteristics. Healthcare utilization (inpatient, outpatient, and pharmacy) and associated costs were collected for each patient and annualized. Mean utilization and costs per patient were then compared between treatment groups using non-parametric Wilcoxon rank-sum tests. LEV and PHT monotherapy patients (n=348 in each group) had similar characteristics: mean age [sim]36 years, [sim]42% men, 37% partial seizures. LEV monotherapy patients showed statistically significantly lower annual mean healthcare utilization than PHT monotherapy patients for emergency-room visits (7.87 vs 11.21, p[lt]0.01), EEGs (0.87 vs 1.13, p[lt]0.01), CT scans (0.35 vs 0.71, p[lt]0.001), magnetic nuclear resonance (0.59 vs 0.97, p[lt]0.01), AED monitoring (0.47 vs 3.43, p[lt]0.001), hematologic function tests (3.12 vs 3.78, p[lt]0.01), hepatic function tests (0.96 vs 1.60, p[lt]0.001) and hospitalizations (0.34 vs 0.64, p[lt] 0.01). Generally, decreased resource utilization translated into less cost per patient. While total pharmacy costs were higher for LEV ($2,841 vs $2,054, p[lt]0.001), given higher drug cost for LEV, other healthcare costs were less for LEV (total outpatient: $7,784 vs $8,440, ns; hospitalizations: $5,306 vs $11,857, p[lt] 0.05). Overall costs (pharmacy, outpatient and hospitalizations) were lower for LEV ($15,931 vs $22,351, ns). This study shows that most outpatient and inpatient resource utilization and costs were significantly lower for LEV monotherapy patients than for PHT monotherapy patients. When comparing LEV with a classic first generation AED, healthcare providers should consider all healthcare utilization and costs and not just direct pharmacy costs. (Supported by UCB Pharma.)