Abstracts

Rationale: Surgical treatment of drug refractory epilepsy (DRE) is cost effective, allows for meaningful reduction in seizure burden and anti-seizure medication (ASM) burden, and is largely underutilized. Barriers to epilepsy surgery are well described and health disparities amongst patients that receive surgical treatment, compared to those who do not, have also been reported.



Claims-based research is an avenue for studying these disparities using real-world data. To date, claims data studies extrapolate the population of DRE from prevalence of estimated 20 to 30%, and study individuals who receive epilepsy surgery compared with those who did not receive surgery.



Utilizing state Medicaid insurance data, we measure the number of children with DRE and the number of children who underwent epilepsy surgery in the years 2022 and 2023 to understand disparities pediatric epilepsy surgery.


Methods: We used a pooled sample from NC Medicaid claims for 2022 and 2023 to assess the incidence of surgery among DRE patients aged less than 21 years. Codes for DRE and epilepsy surgery were reviewed by one pediatric surgical epileptologist (JY). All cell sizes with a value less than 11 were suppressed due to reporting guidelines for low-incidence events; Surgery was categorized into VNS, RNS, and AOS (All Other Surgeries). We further examined whether disparities in the incidence differed based on age, gender, race, and ethnicity.

Results: There were 8,517 unique DRE patients in the year 2022-2023 of which 2,487 met age criteria. Of these, 165 (6%) had epilepsy surgery procedure codes. In this sample sEEG, SDE, Hemispherectomy, Callosotomy, LITT, and Resections all did not meet the cell size reporting requirement therefore were combined as All Other. Age distribution included 457 ages 0 to 5, 524 ages 6 to 10, 787 ages 11 to 15, and 704 ages 16-20. Black individuals were 707 (29%), and Hispanic individuals were 350 (14%). Individuals were received VNS were 39% Black and 11% Hispanic. Individuals who received RNS were 18% Black and 14% Hispanic. Individuals who received All Other Surgeries were 15% Black and 17% Hispanic.

Conclusions: This study describes the current state of DRE and epilepsy surgery within one state Medicaid insurance data set. Similar to prior studies, epilepsy surgery utilization remains low at 6%. Black individuals represented 29% of the DRE, a high percentage (39%) of VNS, however a smaller percentage (18% and 15%) of RNS and All Other Surgeries. Further steps include comparison to state private Blue Cross Blue Shield insurance data set, studying years 2020 to 2023, measuring differences between age, race, ethnicity, and geographic distance from residence to Level IV Pediatric Epilepsy Center.

Funding: University of North Carolina-Novant Health Equity Research Advisory Council Promoting Clinical Research in Southeastern North Carolina award HE0101.