The Journey of Medicaid Enrollees with Drug-resistant Epilepsy (DRE) to Neuromodulation
Abstract number :
1.507
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2024
Submission ID :
1478
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Kathryn Evans, MS, MPH – Evidera
Qian Li, PhD – Evidera
Bronwyn Do Rego, MSc – LivaNova Plc.
Ariel Berger, MPH – Evidera
Rationale: Individuals with epilepsy who do not respond adequately to ≥2 different regimens of anti-seizure medications (ASMs) are considered to have DRE. While relevant guidelines recommend consideration of neurostimulators (i.e., vagal nerve stimulation, deep-brain stimulation, responsive neurostimulation) and other non-pharmacologic alternatives for patients with DRE, instead of continued trials of ASMs, available data suggest that such treatments are often deferred for several years following DRE onset. We sought to characterize the healthcare “journey” of Medicaid enrollees with DRE during the 2-year period prior to neuromodulator implantation.
Methods: We used data from the US Centers for Medicare and Medicaid Services (CMS) to identify Medicaid enrollees with DRE who underwent neuromodulator implantation between 1 January 2011 and 31 December 2020. The earliest date on which implantation was noted was designated the index date. Patients without an epilepsy diagnosis on index date were excluded, as were those without any ASM claims in the year prior to implantation and those not continuously enrolled for the two-year period before and including index date (“pre-index”). All available information during pre-index was used to assess selected demographic and clinical characteristics, as well as patterns of use and cost of healthcare services and pharmacotherapy. Analyses alternatively employed an all-cause and epilepsy-related perspective; the latter was defined as all medical care (inpatient and outpatient) resulting in diagnoses of epilepsy and all ASM dispenses.
Results: A total of 2,469 patients with DRE met all study selection criteria. Mean (SD) age was 20.8 (14.1) years (52% were < 18 years); 53% were male; 49% were non-Hispanic White. Forty-one percent had diagnosed learning disabilities; 32%, hemiplegia or paraplegia; 20%, anxiety; and 17%, depression. Almost one-half (45%) of patients received ≥5 unique ASMs during the two-year pre-index period; 57% and 83% had ≥1 hospitalizations and ≥1 emergency department (ED) visits, respectively, during this period. Most (97%) hospitalizations and ED visits (80%) were epilepsy-related. Median (Q1 – Q3) pre-index healthcare costs were $64,462 ($25,527 – $146,876) and $22,710 ($7,624 – $53,897)). Mean monthly all-cause healthcare costs increased by 61% during pre-index (from $4,184 in month 24 before index to $6,727 in the month prior to index); epilepsy-related costs, by 155% (from $1,486 to $3,782, respectively) (Figure 1).
Conclusions: Medicaid patients with DRE experience high levels of all-cause and epilepsy-related use and cost of healthcare services and prescription pharmacotherapy during the 2-year period prior to neuromodulator implantation that increase substantially over that period. They also carry a relatively high comorbidity burden, including mental health disorders. Further research is needed to determine whether earlier implantation of neuromodulators and/or use of non-ASM interventions can alleviate the burden of DRE among this particularly vulnerable patient population.
Funding: This study was funded by LivaNova.
Health Services (Delivery of Care, Access to Care, Health Care Models)