Abstracts

Rationale: There is limited information about what drives healthcare utilization and costs during healthcare transition from pediatric to adult settings for patients with epilepsy. During transition, young adults may use costly emergency care for seizure control rather than establish care with an adult neurologist. Patients may also “bounce back” to pediatric care or skip first adult appointments, adding to time costs for patients, clinicians, and healthcare systems. A crucial next step in epilepsy research for adolescents and young adults (AYA) is to examine factors driving healthcare utilization and costs during transition. This project examined predictors of healthcare utilization and healthcare costs for AYA transitioning to adult epilepsy care.

Methods: Participants (N=80, M_age=17.3, 86.6% White Non-Hispanic, 53.7% female) with epilepsy were identified via medical records. All were 15-30 years old seen by outpatient neurology providers between 2015-2018 (at least one pediatric and one adult visit). Healthcare utilization variables included (1) days from last pediatric to first adult outpatient epilepsy visit, (2) outpatient epilepsy clinic visits, (3) emergency department visits related to epilepsy, and (4) inpatient hospitalizations related to epilepsy. Cost data (gross charges to patients) were obtained from the hospital system.

Results: Minority race, public vs. private insurance, older generation AEDs, seizure occurrence, patient age, and sex were examined for potential predictors to change in utilization from pre to post transition. However, no significant results emerged (all ps > .05). Total costs to patients were over $2.5 million during study period (M=$7812 per patient per year). Further analyses related to cost data are currently underway (completion 7/2022). We will compare how costs during transition vary across individuals (age, sex, epilepsy diagnosis, comorbidities, and seizure frequency) for presentation.

Conclusions: We examined patient and disease factors related to healthcare utilization and costs. Overall, our participants’ costs were lower than previous reports. Previous research reports direct costs of epilepsy range from $10,000 to nearly $48,000 per person annually (Begley and Durgin, 2015). A possible reason for lower reported costs compared to reports in other studies may be that patients in this study reside in rural North Carolina, and often have trouble accessing care. Our results identify potential targets to reduce healthcare costs and improve understanding of how transition affects patients with epilepsy and the larger rural-serving healthcare system. Next steps include a comparison of our cost data with national databases (e.g., Healthcare Cost and Utilization Project) and further exploration of predictors of healthcare utilization.

Funding: This work was supported by the American Epilepsy Society through the Junior Investigator Award awarded to Aimee W. Smith, PhD.