Authors :
Presenting Author: Elaine Kiriakopoulos, MD, MPH, MSc – Geisel School of Medicine at Dartmouth
Erica-Lyn Plante, MS – IHPP at the University of New Hampshire; Marcy Doyle, DNP – IHPP at the University of New Hampshire; Chris White, BS – IHPP at the University of New Hampshire; Kelly Dixon, MPH – IHPP at the University of New Hampshire; Amy Costello, MPH – IHPP at the University of New Hampshire; Barbara Jobst, MD, dr. Med – Geisel School of Medicine at Dartmouth; Jeanne Ryer, MSc, EdD – IHPP at the University of New Hampshire
Rationale: br>Epidemiologic data are essential for evaluating the community burden of epilepsy and improving equitable access to care. In New Hampshire (NH) where access to specialist care and support services varies by geography, the unit cost of individual health care encounters associated with non-adherence to medical therapy is an important component of the economic burden of epilepsy on the state’s rural healthcare system. This study employs
administrative claims and enrollment data to estimate the prevalence of inpatient epilepsy encounters by county and provides an estimate of antiseizure medication (ASM) adherence prescription refill data.
Methods:
A retrospective descriptive analysis was conducted using NH's All-Payer Claims Database (
New Hampshire Comprehensive Health Care Information System). Medical and pharmacy claims and enrollment data for individuals with commercial insurance policies based in NH, NH Medicaid and NH Medicare were selected for this study. Data was aggregated to county. Members included in the analysis had at least nine months of both medical and pharmacy enrollment during the 12-month analytic period and were residents of NH. Enrollees were identified as having epilepsy if at least one ICD 10 diagnosis code beginning with G40 appeared on a claim during the analytic period. Prescription fills for ASMs were identified using Wolters-Kluwer’s Lexicomp drug classification system. Claims originating from inpatient confinement files were used to identify inpatient stays. Analysis was conducted using SAS and data visualizations created using Tableau.
Results:
Analysis demonstrated in 2019, the total percentage of people with epilepsy residing in NH ranged from 3% in Coös county to 29% in Hillsborough county. T
he percentage of total members with epilepsy and no ASM fills ranged from 3% in Sullivan county to 30% in Hillsborough county. Geospatial mapping of claims data demonstrated inpatient hospitalizations for epilepsy were highest in the Medicaid population with striking elevation in northern NH, a region with a known higher Area Deprivation Index (Fig 1). Inpatient encounters were lowest among PWE with Commercial insurance across all counties. Marked differences were observed across all counties for the Medicaid population vs Commercial and Medicare groups, when comparing inpatient encounters for those with versus those without medication refills (Fig.2). A greater than five-fold increase in inpatient stays was observed in Coös and Carroll Counties - both with significant area deprivation indices and underserved communities. Conclusions:
Significant variations in epilepsy health care utilization exist across NH. Differences highlight the importance, and the difficulty, of developing systems of care to manage complex chronic conditions in rural, socioeconomically and underserved populations. Reducing the incidence of hospitalizations associated with treatment non-adherence could prove to be a significant cost-saving for insurers and patients. Future research is needed to determine locally relevant factors, which may then be used to derive meaningful place-based interventions for patient and provider communities.
Funding: n/a