Compared with other races/ethnic groups, black Medicare beneficiaries have higher costs following an epilepsy event. Poor adherence to antiepileptic drugs (AEDs) and a higher number of comorbidities increase the risk for incurring higher costs associated with care. This is according to random Medicare sample analysis findings published in Epilepsia.
Administrative claims data for seizures and/or epilepsy between 2008 and 2010 from the Center for Medicare and Medicaid Services were obtained to form a longitudinal cohort of a random sample of Medicare beneficiaries (age ≥67 years). A second cohort was augmented for representation of US minorities, including black (62%), Asian/Pacific Islander (5%), Hispanic (11%), and American Indian/Alaskan Native (2%) beneficiaries. All epilepsy cases (n=36,912) featured one or more International Classification of Diseases, Ninth Edition (ICD‐9) 345.x or two or more ICD‐9 780.3x claims and were treated with one or more antiepileptic drugs (AEDs) in 2009. New epilepsy cases (n=3706) were included in the cohort if they had no seizure/epilepsy claims or treatment with AEDs in the previous year (365 days).
Study researchers assessed costs by measuring reimbursements for all care. A follow-up one-year cost in the 75th percentile or higher defined “high costs” of care. The study evaluated the association between high costs and race/ethnicity in analyses adjusted for demographic, clinical, economic, and treatment quality variables. Costs from two 6-month periods prior to and two after the index event were also obtained for cases with continuous two-year data available.
In the follow-up period, the mean cost across all races/ethnicities was approximately $30,000 (median, $11,547; new cases, [mean] $44,642 vs [median] $25,008).
Variables significantly associated with high costs were having one or more comorbidity, neurologic care, and low AED adherence. Beneficiary cases with low adherence to AEDs exhibited a greater likelihood of incurring high costs (odds ratio [OR], 2.66; 95% CI, 2.52‐2.80). Comparatively, lower odds of high costs were associated with being at risk for drug interactions (OR, 0.80; 95% CI, 0.68‐0.95). Compared with white patients with epilepsy, black patients with epilepsy had higher odds of high costs (OR, 1.20; 95% CI, 1.11‐1.29) in all cases, as well as in new cases (OR, 1.66; 95% CI, 1.29‐2.14). The association between black beneficiaries and higher costs compared with white beneficiaries was only marginally significant when controlling for AED nonadherence (OR, 1.09; 95% CI, 1.01‐1.18; P =.03).
A limitation of the analysis was the inclusion of only Medicare beneficiaries age ≥67 years, limiting the ability to generalize these findings across the epilepsy population at large.
Future analyses that focus on elucidating the reasons for greater healthcare utilization as well as the quality of care received in patients with epilepsy may “inform the necessary interventions and programs to ensure a life free of seizures and side effects, including financial side effects, for all groups of older adults with epilepsy,” concluded the investigators.
The study researchers report financial interests with National Institutes of Health, National Science Foundation, Shor Foundation for Epilepsy Research, Department of Defense, UCB Biosciences, NeuroPace, SAGE Therapeutics, Serina Therapeutics, Greenwich Biosciences, Biogen, GW Pharmaceuticals, and Eisai.
Pisu M, Richman J, Szaflarski JP, et al. High health care costs in minority groups of older US Medicare beneficiaries with epilepsy [published online June 6, 2019]. Epilepsia. doi:10.1111/epi.16051