Burden of uncontrolled epilepsy in patients requiring an emergency room visit or hospitalization

• DOI: 10.1212/wnl.0b013e318271f77e
• Publication Date: 2012-10-18T18:40:57Z
• Authors: Ranjani Manjunath; Pierre Emmanuel P...; Hélène Parisé; Marie-Hélène Lafe...; Brian Bowers; Mei Sheng Duh; Patrick Lefebvre; Edward Faught
• Keywords: Adult; Male; Epilepsy; Medicaid; Incidence; Middle Aged; United States; 3. Good health; Cohort Studies; Hospitalization; 03 medical and health sciences; 0302 clinical medicine; Humans; Anticonvulsants; Female; Longitudinal Studies; Morbidity; Emergency Service, Hospital; Aged; Retrospective Studies

<h3>Objective:</h3> To quantify the clinical and economic burden of uncontrolled epilepsy in patients requiring emergency department (ED) visit or hospitalization. <h3>Methods:</h3> Health insurance claims from a 5-state Medicaid database (1997Q1–2009Q2) 55 self-insured US companies ("employer," 1999Q1 2008Q4) were analyzed. Adult with receiving antiepileptic drugs (AED) selected. Using retrospective matched-cohort design, categorized into cohorts "uncontrolled" (≥2 changes AED therapy, then ≥1 epilepsy-related ED visit/hospitalization within 1 year) "well-controlled" (no change, no visit/hospitalization) epilepsy. Matched compared for health care resource utilization costs using multivariate conditional regression models nonparametric methods. <h3>Results:</h3> From 110,312 (Medicaid) 36,529 (employer) eligible patients, 3,454 602 matched 1:1 to well-controlled epilepsy, respectively. In both populations, presented about 2 times more fractures head injuries (all <i>p</i> values &lt; 0.0001) higher (ranges adjusted incidence rate ratios [IRRs] [all-cause utilization]: AEDs = 1.8–1.9, non-AEDs 1.3–1.5, hospitalizations 5.4–6.7, length hospital stays 7.3–7.7, visits 3.7–5.0, outpatient 1.4–1.7, neurologist 2.3–3.1; all than groups. Total direct (adjusted cost difference [95% confidence interval (CI)] $12,258 [$10,482–$14,083]; employer $14,582 [$12,019–$17,097]) vs patients. Privately insured employees lost 2.5 work days, associated indirect $2,857 (95% CI $1,042–$4,581). <h3>Conclusions:</h3> Uncontrolled hospitalization was significantly greater increased publicly privately settings.