Abstracts

Rationale: Although health resource utilization (HRU) in patients with convulsive disorders is the starting point for economic analysis of the medical burden of these conditions, little research describes the components of patients’ care. Thus, we aimed to evaluate HRU in patients with active epilepsy. Methods: Thomson-Reuters insurance databases included 14 million persons in 2005-2007. We extracted information for individuals with insurance claims suggestive of epilepsy. Using iterative expert classification, we sorted patients by type of epilepsy. For each type we calculated prevalence and HRU. A distance analysis identified closely similar types, and a principal components analysis revealed dimensions of variation in HRU. Results: The prevalence of active epilepsy was 3.4/1000. Most common diagnoses among 46,847 patients were generalized convulsive epilepsy (33.3%) and complex partial seizures (24.8%). Patients averaged 10 physician visits/yr, 24 diagnostic tests/procedures/yr, >30 drug dispensings/yr, and <1 ER visit/yr; the minority of these being related to epilepsy. Females generally had more HRU and HRU increased with age. Patients were hospitalized most frequently for disorders other than epilepsy. HRU was similar for most epilepsy types, excepting grand mal status, epilepsia partialis continua, and infantile spasms. The first principal component of HRU variation was non-epilepsy HRU, followed by components of epilepsy-related medications, other epilepsy/emergency care, and epilepsy visits/diagnostic procedures. Conclusions: The prevalence of active epilepsy in the US is substantially less than the prevalence of any history of recurrent seizure. Non-epilepsy-related HRU dominated HRU in epilepsy patients and was the principal source of variation. There is a core set of epilepsy diagnoses whose HRU pattern are indistinguishable, while patients with grand mal status, epilepsia partialis continua, and infantile spasms all have distinct patterns. To provide more specific insights into the economic impact of the condition, studies of HRU in epilepsy should make a distinction about epilepsy-related and unrelated care.