Abstracts

Rationale: Most patients with epilepsy require long-term treatment with anti-seizure medications (ASM). However 30-40% of adult patients fail to respond to treatment and most patients who attain control do so with the first or second ASM (“Laxer KD et al. The consequences of refractory epilepsy and its treatment. Epilepsy Behav. 2014 Aug;37:59-70.”). The probability of achieving seizure freedom diminishes substantially with each subsequent ASM. Epilepsy, especially DRE, is associated with high healthcare costs and comorbidity, including psychological disorders such as depression. We aimed to assess real-world treatment patterns and healthcare costs prior to neurostimulation in patients with DRE in the US.

Methods: We identified patients with the diagnosis of epilepsy who underwent surgery for neurostimulator implantation (Vagus Nerve Stimulation, Responsive NeuroStimulation, or Deep Brain Stimulation) from 2012 through 2019 using the IBM MarketScan® Commercial and Medicare Supplemental database. These procedures were identified using relevant procedure codes. The index date was the date of the earliest neurostimulation procedure. For inclusion, patients were required to have used ≥1 ASM during the 24-month pre-index period, hereafter referred as the “pre-index period.” Patient characteristics, ASM use and healthcare costs were summarized descriptively using information from the pre-index period.

Results: A total of 1,795 patients who underwent a neurostimulation procedure were identified. Median age of patients was 36.3 years; children < 18 years old comprised 19% of the sample. The five most common co-existing diagnoses were anxiety (27.5%), chronic pulmonary disease (21.1%), depression (21.0%), cerebrovascular disease (20.6%), and hemiplegia/paraplegia (16.3%). An average of 3.4 ASMs per patient were prescribed during the pre-index period; nearly one-half (43.4%) of patients received ≥4 ASMs. The most frequently prescribed ASMs were: levetiracetam (47.2%), lamotrigine (33.3%) and clonazepam (29.3%).

Conclusions: The patient journey prior to neurostimulation is characterized by high annual per-person healthcare costs of $62,408 compared with the average per-person expenditure of $10,739 reported for the overall US population in 2017. The cost burden for these neurostimulation patients was predominantly attributable to epilepsy. Patients had a high level of ASM use with multiple medication changes.

Funding: Please list any funding that was received in support of this abstract.: Funding Source: LivaNova.