Authors :
Presenting Author: George Morris, MD, MPH, DIC – Ascension Wisconsin, St. Mary's Hospital, Milwaukee, WI, USA
Derek Ems, MPH, CPHQ – UCB, Smyrna, GA, USA
Anna Kuba, MSc – UCB, Warsaw, Poland
Milena Tryfon, MSc – UCB, Warsaw, Poland
Pam Eads, MBA – UCB, Smyrna, GA, USA
Rationale:
Midazolam (MDZ) nasal spray was approved in the USA in 2019 for acute treatment of intermittent, stereotypic episodes of frequent seizure activity (i.e., seizure clusters, acute repetitive seizures). The MDZ nasal spray approval allows for non-hospital management of acute seizures and potential reduced healthcare resource utilization (HCRU). This study assessed demographics at baseline and comorbidities, treatment patterns, HCRU, and healthcare costs of patients with epilepsy in Wisconsin prior to and following MDZ nasal spray prescription.Methods:
This study was a noninterventional, retrospective, claims-based cohort analysis using the Wisconsin Health Information Organization (WHIO) All-Payer Claims Database, which includes inpatient and outpatient care, radiology, pharmacy, and laboratory services. The index date was the first date on which all inclusion criteria were met: patients had to be ≥ 12 years of age at first MDZ nasal spray prescription and had to have ≥ 1 prescription claim for MDZ nasal spray in the identification period (Dec 01, 2019–Jun 30, 2020), continuous medical and pharmacy enrollment for 1 year prior to the index date (baseline period), and an epilepsy diagnosis (ICD-10: G40.X, R56.X, G25.3) and ≥ 1 prescription claim for a chronic ASM during the baseline or identification period. Patient follow-up started on the index date and ended at the end of continuous enrollment, 365 days post-index date, or at data cut-off (Jun 30, 2021), whichever was earliest. All variables were summarized using descriptive statistics.Results:
During the identification period, 132 patients had filled ≥ 1 prescription for MDZ nasal spray; 109 of these fulfilled all inclusion criteria and were included in this analysis. Of these 109 patients, 48.6% were female, mean (SD) age was 23.8 (8.5) years, and 79.8% were on Medicaid (Table 1). Reductions in all-cause HCRU from baseline to follow-up were seen in mean inpatient stays (0.39 to 0.24), mean outpatient visits (10.81 to 8.64), mean emergency department (ED) visits (2.01 to 0.88), mean other visits (11.62 to 9.15), and mean paramedic transport use (14.99 to 3.46) (Fig. 1A). Similarly, reductions in epilepsy-related HCRU were seen in mean inpatient visits (0.35 to 0.24), mean outpatient visits (4.52 to 3.47), mean ED visits (1.36 to 0.48), mean other visits (2.96 to 2.13), and mean paramedic transport use (0.88 to 0.18) (Fig. 1A). These reductions were expressed in all-cause cost reductions from baseline to follow-up for mean medical services ($76,777 to $42,418) and mean total costs ($103,155 to $79,706); mean pharmacy costs increased ($26,378 to $37,288) (Fig. 1B). Similarly, reductions in epilepsy-related costs were seen for mean medical services ($61,049 to $31,423) and mean total costs ($69,393 to $47,621); mean pharmacy costs increased ($8344 to $16,198) (Fig. 1B).Conclusions:
HCRU and costs were reduced following introduction of MDZ nasal spray. Increases in mean pharmacy costs were offset by reduced inpatient, ED, and outpatient visits and reduced total costs. While not assessed in this analysis, quality of life improvements may be experienced with these reduced inpatient and ED visits.
Funding:
UCB-sponsored