Abstracts

Rationale: The influence of socio-demiographic factors such as race and insurance status on access to epilepsy surgery has been well-studied; however the influence of these factors on AED selection is less characterized. In comparison with the so-called first generation AEDs, the second generation AEDs have a better safety and tolerability profile, but second generation AEDs are typically more expensive. The goal of this study was to determine if insurance status was associated with use of first or second generation AEDs in children and adults with partial epilepsy. Methods: A retrospective study was performed using the Northeast Regional Epilepsy Group database covering the period of June 2007 to April 2009. Children and adults with partial epilepsy and known insurance status were included in the analysis. Carbamazepine, phenobarbital, phenytoin, primidone, and valproate were classified as first generation AEDs, and gabapentin, lamotrigine, levetiracetam, oxcarbazepine, pregabalin, topiramate, and zonisamide were classified as second generation AEDs. Acetazolamide, ACTH, benzodiazepines, felbamate, tiagabine, and vigabatrin were excluded from the analysis. Insurance status was classified as private insurance (private, HMO, PPO, etc.), Medicare (including Medicare contracting organizations), Medicaid, or self-pay. Results: A total of 1323 patients were included in the analysis: 811 (61%) had private insurance, 348 (26%) had Medicare, 122 (9%) had Medicaid, and 42 (3%) were self-pay. Chi-square analysis revealed that patients with private insurance were significantly less likely than patients with other insurance status to have been treated with first generation AEDs (p < 0.001). No significance differences existed for insurance status and treatment with a second generation AEDs, but fewer self-pay patients (66%) were ever treated with a second generation AED in comparison with private insurance (75%), Medicare (76%), or Medicaid (70%). Conclusions: Children and adults with partial epilepsy with Medicare, Medicaid, or who are self-pay are significantly more likely to be treated with first generation AEDs than patients with private insurance, but equally likely to be treated with second generation AEDS. Clinicians therefore appear to prefer using second generation AEDs when possible. Further analysis will explore the role of other variables such as etiology, setting of initial diagnosis, and race/ethnicity.