Abstracts

Rationale: Insurance-borne cost of healthcare resource use in patients with epilepsy is usually reported as total expenditure over a defined time period. However, in a disease characterized by acute exacerbations, the unit cost of individual healthcare encounters associated with exacerbations, in this case seizures, is an important component of the economic burden of epilepsy, and provides a basis for estimating the possible value of preventing seizures to insurers, patients, and society at large. Methods: This retrospective cohort study used IBM MarketScan Commercial Claims (CCMC), Medicare Supplemental and Coordination of Benefits (Medicare patients with supplemental insurance; MDCR), and Multi-State Medicaid research (MDCD) databases, which are Health Insurance Portability and Accountability Act (HIPAA) compliant. The primary analysis calculated the unit cost of epilepsy-related healthcare encounters, defined as having a primary diagnosis code of epilepsy or convulsion, to the insurer (adjudicated claims), in the last 5 years of data availability (2014-2018 for CCMC and MDCR, 2013-2017 for MDCD), in patients with epilepsy aged ≥12 years, adjusted to 2018 prices. Patients with epilepsy were defined as having either one epilepsy ICD code, or two convulsion ICD codes and ≥1 antiepileptic drug claim. Patients on capitated insurance plans were excluded as their unit cost of care is unknown. Results: The analysis included 353,530 commercially insured, 378,051 Medicaid, and 69,176 Medicare plus supplemental insurance patients with epilepsy (Table 1). More than 160,000 epilepsy-related emergency transportations, 225,000 Emergency Department (ED) visits, 49,000 hospitalizations, 700 urgent care visits, and ~2.5 million office visits were analyzed. 37% of epilepsy-related hospitalizations included care in the intensive care unit (ICU), compared with 29% of all hospitalizations in patients with epilepsy. In commercially insured patients, epilepsy-related healthcare encounters were associated with a median (Q1-Q3) unit cost to insurers of $687 ($415-$1,083) (emergency transportation), $1,913 ($417-$4,163) (ED visit), $22,305 ($14,336-$36,096) (hospitalization). Other costs are reported in Table 2. In working age commercially insured patients, the median (Q1-Q3) length of stay of an epilepsy-related hospitalization is 4 (2-5) days. Conclusions: No single study thus far has reported data on the unit cost of epilepsy related healthcare encounters to insurers. Reducing incidence of encounters associated with epilepsy could prove cost-saving for insurers and patients, and avoid work/caregiver time loss for patients. Funding: UCB Pharma-sponsored