Use on Neuromodulation (NM) for the Treatment of Medicare Enrollees with Drug-Resistant Epilepsy (DRE): Does Race/Ethnicity Still Play a Role?
Abstract number :
3.403
Submission category :
17. Public Health
Year :
2023
Submission ID :
1145
Source :
www.aesnet.org
Presentation date :
12/4/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Vanessa Danielson, MSc – LivaNova
Sandi Lam, MD, MBA – Ann and Robert H Lurie Children Hospital; Kathryn Evans, MS, MPH – Evidera; Tom Vincent, MPA, MPH – Evidera; Qian Li, PhD – Evidera; Lu Zhang, PhD – Ann and Robert H Lurie Children Hospital; Reginald Lassagne, MSc – LivaNova; Ariel Berger, MPH – Evidera
Rationale: While NM has been shown to be an effective treatment for DRE, prior research has identified a number of disparities in its use (along with other non-pharmacologic interventions), including but not limited to race. The aim of this study was to examine the role race/ethnicity plays in the use of NM among Medicare enrollees with DRE, along with use and cost of healthcare services during the two year “journey” to the procedure.
Methods: Using healthcare claims for all fee-for-service Medicare enrollees in the United States, we identified all patients who underwent NM implantation for DRE between 2012 and 2019. The earliest date during this period on which evidence of NM implantation was identified was designated the index date. Patients without an epilepsy diagnosis on index date were excluded, along with those without: (1) ≥1 claims for anti-seizure drugs in the year prior to index, (3) continuous enrollment in the two years prior to index (“pre-index”), or (4) recorded race/ethnicity data. Patients were stratified by race and ethnicity. Demographic and clinical characteristics were assessed over pre-index, as were patterns of use and cost of healthcare services. Care was assessed alternatively as all-cause or epilepsy-related; the latter was defined as all medical care resulting in diagnoses of epilepsy and all ASM dispenses. Chi-square tests were used to assess the statistical significance of differences between groups.
Results: A total of 3,516 patients with DRE met all study selection criteria; 78% were White, 10% black, 8% hispanic, and 3% other. Mean (SD) age ranged from 43.7 (11.3) years for those of “other” ethnicity to 47.4 (13.3) years for white patients. Comorbidities were common, with some differences noted for specific comorbidities across groups (e.g., 48% of white and 40% of black patients had depression). While most patients experienced hospitalizations during pre-index, black patients were most likely to be admitted on both an all-cause and epilepsy-related basis (p< 0.01 for both comparisons) (Figure). Most patients also had ≥ 1 emergency department (ED) visits, with black patients most likely to have epilepsy-related ED visits. Total median (Q1 - Q3) epilepsy-related pre-index healthcare costs were $27,610 (12,802 - 54,498) for white, $31,435 (17,017 - 56,313) for black, $27,885 (13,128 - 53,455) for hispanic, and $31,484 (13,087.5 - 63,033.8) for other patients.
Public Health