Abstracts

Rationale: How antiepileptic drugs (AEDs) are used in the United States (US) is a public health indicator for the current state of epilepsy management. The use of phenytoin, and older and newer AEDs (Figs 1, 2) also may act as indicators for the quality of epilepsy practice. Data on AED use in US states and populations can help identify which public health interventions are necessary to improve the status of epilepsy care. The objective of this project undertaken by the Epilepsy Foundation's Connectors group is to identify the current status of US AED use and assess geographic variations to best identify targeted locations to improve epilepsy care. Methods: IMS Health is a comprehensive database of US longitudinal retail prescription and office medical claims data identifying patients with a confirmed epilepsy diagnosis and prescribed AEDs for each US state. All de-identified patients with an AED prescription over a 3-year period from Jan 2013 to Dec 2015 were included. Inclusion criteria were patients who received an AED and had an epilepsy diagnosis in the 2-year period before their 1st AED prescription in the reporting period. Percentages of patients initially prescribed phenytoin, and older and newer AEDs were calculated and stratified by state and included Washington DC (DC). Patients were considered newly treated if they had not received an epilepsy drug in the previous 1-year period preceding the first AED script in the reporting period. Data are reported using the moving average annual total (MAT) ending Dec 2015. Results: ~2.5 million US epilepsy patients were identified from 2013 to 2015; 237,347 patients were newly treated. Predictably, states with the highest population had the highest volume of epilepsy patients prescribed an AED, including California, Florida, New York, and Texas. States with the highest total proportion of phenytoin use with the lowest proportion of newer AED use were Mississippi (24.4%, 53.1%, respectively) and DC (24.7%, 58.1%); Montana had the lowest proportion of phenytoin use with the highest proportion of new AED use (7.9%, 70.4%; Fig 1). For newly treated patients (Fig 2), Hawaii (39.1%) and Alaska (38.8%) had the highest percentage of phenytoin use compared to all other states. Idaho and Montana had the highest proportion of newer AED use (86.1%, 84.4%); DC (50.9%) and Hawaii (60.9%) had the lowest proportion of patients treated with newer AEDs; North Dakota and DC had the highest use of older AEDs (29.6%, 27.9%). Conclusions: A significant proportion of US epilepsy patients are underserved in regard to newer AED use with Mississippi and Washington DC having the highest proportion of phenytoin use relative to new AED use. Understanding the socioeconomic and demographic barriers for these observations are essential in planning interventions to improve the quality of life and quality of care for new and current US epilepsy patients. These data provide a baseline to target educational and clinical interventions for improving the quality of US epilepsy care. Funding: UCB Pharma-sponsored.