Abstracts

Rationale: Epilepsy affects more than 2 million people in the United States (U.S.). Only a few studies have been published that reveal its direct cost. Our primary objective was to estimate the health plan paid cost of epilepsy during year 2009. A second objective was to show the major cost drivers of the health plan paid cost for the treatment of epilepsy patients. An accurate determination of epilepsy costs is necessary to understand the use of healthcare resources and evaluate the cost effectiveness of diagnostic and therapeutic interventions.Methods: Data came from six health plans located in different parts of the U.S. These health plans were among plans contracting with Accordant Health Services for disease management of rare and/or chronic conditions like epilepsy who gave permission to use their data for research and publication. Epilepsy patients were match-paired with non-epilepsy members insured within the same six health plans using propensity scores derived from demographic characteristics including gender (female vs. male), age group (less than 45 years vs. 45 years and older), health plan product (Commercial vs. Medicare), and length of enrollment (partial vs. continuous enrollment). Health care claims data for year 2009 were analyzed for the two comparison groups and the difference in average total health plan dollars paid per member per year ($, PMPY) was expressed as the annual health plan paid cost of epilepsy. The relative distribution (%) of total paid amounts was determined by place of service (POS) to determine cost driver(s) of the health plan paid cost for epilepsy.Results: A total of n=5,810 epilepsy patients were match-paired with n=5,810 non-epilepsy controls. Each of these two comparison groups had: Females 53%, Males 47%, average age 36 years; Medicare product 4%; Commercial product 96%; Partial-year enrolled 18% and continuously enrolled 82%. Average total health plan paid cost ($, PMPY) was $11,232 (95% CI $10,692 to $11,772) for the epilepsy group and $3,026 (95% CI $2,872 to $3,180) for the match-paired control group (p<0.001). The excess cost for members with epilepsy was $8,206 ($11,232-$3,026). Relative distribution of total health plan paid costs ($) by POS for the epilepsy group was inpatient (40%), outpatient (22%), MD office (14%), pharmacy (12%), home health (5%), and other (7%). Relative distribution of total health plan paid cost ($) by POS for the match-paired control group was inpatient (27%), outpatient (29%), MD office (26%), pharmacy (9%), home health (2%), and other (7%).Conclusions: The estimated direct health plan paid cost PMPY for members with epilepsy in 2009 was $8,206 greater than controls. The top three cost drivers of epilepsy were inpatient (40%), outpatient (22%), and MD office (14%) of the total health plan paid costs for epilepsy.