Abstracts

Rationale: The primary goal in treating children with epilepsy is to achieve seizure control with no adverse side effects while optimizing quality of life. The cost of medical care for youth with epilepsy is substantial in the first year following diagnosis. Identifying patients at risk for incurring disproportionately higher health care charges can inform resource allocation and ultimately reduce health care costs. The aim of this study was to examine differences in health care charges in the 12 months following diagnosis among youth with epilepsy based on longitudinal health-related quality of life (HRQOL) course.Methods: A total of 171 youth with epilepsy (M age=8.9±4.1years; 85% Caucasian; 39% idiopathic localization-related, 37% idiopathic generalized; 96% prescribed AED at diagnosis) participated in this study. Chart reviews were conducted to extract scores from a parent-proxy HRQOL measure, the PedsQL™. HRQOL scores were collected at two time points: the epilepsy diagnosis visit and 12-month follow-up visit. PedsQL™ total scores at both time points were dichotomized (""high"", ≤ 1 SD above the mean; ""low"",> 1 SD below the mean) based on previously published population means and used to classify patients into one of four HRQOL groups: 1) stable low (low-low); 2) declining (high-low); 3) improving (low-high); or 4) stable high (high-high). Charges of all medical encounters in the year following epilepsy diagnosis were obtained from the institution's accounting database. Charges were summed at the encounter level and classified as an outpatient clinic visit, hospital admission, ED visit, laboratory test, or diagnostic procedure.Results: After controlling for seizures, results indicated that patients with declining HRQOL incurred higher health care charges for epilepsy-related hospital admissions (M = $19,021.66, SD = $49,930.11) than patients in the stable high HRQOL group (M = $2,888.49, SD = $9,877.12, d = .77, 95% CI: .27 – 1.27). As a result, they also incurred higher total charges in the year following diagnosis (M = $37,381.10, SD = $56,756.68) compared to patients with stable high HRQOL (d=.83, 95% CI: .33, 1.33). Similarly, patients with stable low HRQOL incurred higher total charges (M = $24,953.16, SD = $24,878.93) than stable high patients (M = $15,788.34, SD = $15,966.85, d = .50, 95% CI: .11 - .89).Conclusions: This study highlights the need for healthcare teams providing pediatric epilepsy care to regularly monitor HRQOL, which may serve as a proxy for future health care use and charges. Routine screenings may help identify patients with persistently low or declining HRQOL who might benefit from psychological services, including interventions targeted at physical, emotional, social, and school functioning.