Abstracts

Rationale: Epilepsy is the fourth most-common neurological disorder, affecting nearly 470,000 pediatric (0-17) patients in the United States. Focal seizures (FS) comprise up to 60% of the pediatric epilepsy cases. The third-generation antiepileptic drug (AED) eslicarbazepine acetate (ESL) is indicated to treat FS in pediatric patients aged 4 years and older. ESL was approved for use in FS patients between 4 to 17 years in September 2017. There is limited information on the use of ESL in routine clinical practice and impact on health service use post-treatment with ESL. This study assessed the impact of initiating treatment with ESL on health care resource use (HRU) among pediatric patients with treated FS. Methods: Symphony Health’s Integrated Dataverse® claims data for 04/01/15–06/30/18 were used. Patients had FS diagnosis (ICD-9/10-CM codes 345.4x, 345.5x, G40.1x, G40.2x), a first dispensed claim for ESL (index date), ≥90 days of data pre- and post-index date, ≥1 medical and pharmacy claim post-index date, and were 4–17 years of age at index date. Demographic and clinical characteristics were studied at baseline; i.e., 90 days before index date. Follow-up HRU outcomes were measured over four 90-day time periods following the index date as any claims for all-cause or FS-related inpatient (IP), emergency room (ER), outpatient hospital (OP), or office (OF) visits. Fixed effects regression models were used to assess within-person changes from baseline to follow up in proportions of patients with any HRU. Results: 234 patients met the inclusion and exclusion criteria. The mean age of the sample was 13.2 years, with an equal proportion of male and female patients. Most patients were enrolled in commercial (51.3%) or Medicaid (44.4%) plans. 42.7%, 37.6%, and 36.8% of patients had other medical (e.g., gastrointestinal disorder, musculoskeletal disorder), neurological (e.g., headache disorder, cerebral palsy), and developmental and psychiatric disorders (e.g., autism, attention deficit hyperactivity disorder, intellectual disability). Patients averaged approximately 2 prior AEDs before initiating ESL. At baseline, 12.8%, 26.1%, 54.3%, and 72.2% of patients had ≥1 all-cause IP, ER, OP, and OF visit, respectively. For FS-related causes, 38.0% of patients had an OF visit, 18.8% had an OP visit, 9.0% had an IP stay, and 3.4% visited the ER. Following ESL initiation, there were statistically significant reductions in the proportions of patients with an all-cause visit for ER (−11.3 percentage points [pp]; P=0.001), OP (−15.1 pp; P<0.001) and OF (−14.9 pp; P<0.001). Statistically significant reductions were observed in any use of focal seizure-related IP (−4.7 pp; P=0.037) and OF (−13.7 pp; P<0.001) (see Figure). Conclusions: This real-world study of pediatric patients with treated FS suggests that ESL initiation was associated with a reduction in all-cause healthcare use, including ER, OP, and OF visits, and other medical services, as well as reductions in FS-related IP and OF visits. Additional research is needed to understand these associations. Funding: Study funding provided by Sunovion Pharmaceuticals Inc.