Abstract：
BACKGROUND: Seizure clusters are underresearched and associated with adverse outcomes in patients with epilepsy. This study was a noninterventional, retrospective claims-based analysis using the Wisconsin Health Information Organization (WHIO) All-Payer Claims Database to characterize the epilepsy population in Wisconsin, with a focus on prevalence, treatment patterns, and healthcare resource utilization (HCRU) in patients with seizure clusters prior to the introduction of nasal spray rescue medications. This timeframe allows characterization of a historical baseline for future comparisons with newer treatments.
METHODS: Four cohorts were defined: (1) all-epilepsy (all patients with epilepsy); and subcohorts of: (2) patients receiving a monotherapy antiseizure medication (ASM); (3) patients receiving ASM polytherapy; and (4) patients treated for seizure clusters (ie, those taking rescue medications and ≥ 1 ASM). Primary outcomes were HCRU over a 12-month follow-up period, which were descriptively analyzed.
RESULTS: Between 2017 and 2019, 16,384 patients were included in the all-epilepsy cohort; 11,688 (71.3 %) were on monotherapy, 3,849 (23.5 %) were on polytherapy, and 526 (3.2 %) were treated for seizure clusters. Twelve-month retentions to the ASM treatments were 46.7 % (7,895/16,904) in the all-epilepsy cohort, and 40.0 % (4,679/11,688) and 40.1 % (1,544/3,849) in the monotherapy and polytherapy subcohorts, respectively. Rescue medication prescriptions were obtained 1,029 times by the 526 patients in the treated seizure cluster subcohort, with infrequent refill rates (mean 1.6-1.9 times/year). A higher proportion of patients in the treated seizure cluster subcohort had epilepsy-related outpatient visits (89.7 %), other visits (71.3 %), and hospitalizations (25.3 %) than patients in the monotherapy (72.2 %, 50.2 %, 19.3 %, respectively) and polytherapy (83.3 %, 63.3 %, 22.8 %, respectively) subcohorts. Mean (standard deviation) all-cause ($114,717 [$231,667]) and epilepsy-related ($76,134 [$204,930]) costs over 12 months were higher in the treated seizure cluster subcohort than the monotherapy ($89,324 [$220,181] and $30,745 [$145,977], respectively) and polytherapy ($101,506 [$152,931] and $49,383 [$96,285], respectively) subcohorts.
CONCLUSIONS: Patients treated for seizure clusters incurred higher all-cause and epilepsy-related costs and epilepsy-related HCRU than other subcohorts and had infrequent rescue medication refills. The findings of this analysis highlight the need for appropriate treatment for those patients with epilepsy experiencing seizure clusters. The effect of newer rescue medications to alter these findings will be explored in a follow-up study. Regardless, specialist providers with expertise in treating refractory epilepsy and seizure cluster patients may help to reduce the burden of seizure clusters.
METHODS: Four cohorts were defined: (1) all-epilepsy (all patients with epilepsy); and subcohorts of: (2) patients receiving a monotherapy antiseizure medication (ASM); (3) patients receiving ASM polytherapy; and (4) patients treated for seizure clusters (ie, those taking rescue medications and ≥ 1 ASM). Primary outcomes were HCRU over a 12-month follow-up period, which were descriptively analyzed.
RESULTS: Between 2017 and 2019, 16,384 patients were included in the all-epilepsy cohort; 11,688 (71.3 %) were on monotherapy, 3,849 (23.5 %) were on polytherapy, and 526 (3.2 %) were treated for seizure clusters. Twelve-month retentions to the ASM treatments were 46.7 % (7,895/16,904) in the all-epilepsy cohort, and 40.0 % (4,679/11,688) and 40.1 % (1,544/3,849) in the monotherapy and polytherapy subcohorts, respectively. Rescue medication prescriptions were obtained 1,029 times by the 526 patients in the treated seizure cluster subcohort, with infrequent refill rates (mean 1.6-1.9 times/year). A higher proportion of patients in the treated seizure cluster subcohort had epilepsy-related outpatient visits (89.7 %), other visits (71.3 %), and hospitalizations (25.3 %) than patients in the monotherapy (72.2 %, 50.2 %, 19.3 %, respectively) and polytherapy (83.3 %, 63.3 %, 22.8 %, respectively) subcohorts. Mean (standard deviation) all-cause ($114,717 [$231,667]) and epilepsy-related ($76,134 [$204,930]) costs over 12 months were higher in the treated seizure cluster subcohort than the monotherapy ($89,324 [$220,181] and $30,745 [$145,977], respectively) and polytherapy ($101,506 [$152,931] and $49,383 [$96,285], respectively) subcohorts.
CONCLUSIONS: Patients treated for seizure clusters incurred higher all-cause and epilepsy-related costs and epilepsy-related HCRU than other subcohorts and had infrequent rescue medication refills. The findings of this analysis highlight the need for appropriate treatment for those patients with epilepsy experiencing seizure clusters. The effect of newer rescue medications to alter these findings will be explored in a follow-up study. Regardless, specialist providers with expertise in treating refractory epilepsy and seizure cluster patients may help to reduce the burden of seizure clusters.
摘要：
背景：癫痫发作簇研究不足，与癫痫患者的不良结局相关。这项研究是非干预性的，使用威斯康星州健康信息组织（WHIO）所有付款人索赔数据库进行回顾性索赔分析，以表征威斯康星州的癫痫人群，以患病率为重点，治疗模式,以及在引入鼻喷雾救护药物之前癫痫发作患者的医疗资源利用率（HCRU）。该时间范围允许对历史基线进行表征,以便将来与较新的治疗进行比较。
方法：定义了四个队列：（1）所有癫痫患者（所有癫痫患者）；以及以下子队列：（2）接受单一疗法抗癫痫药物（ASM）的患者；（3）接受ASM综合疗法的患者；（4）接受癫痫发作集群治疗的患者（即，那些服用救援药物和≥1ASM的人)。主要结果是在12个月的随访期内HCRU，进行了描述性分析。
结果：在2017年至2019年之间，16,384例患者被纳入全癫痫队列；11,688例（71.3％）接受单药治疗，3849人（23.5%）接受综合疗法，和526（3.2%）的癫痫发作集群治疗。在所有癫痫队列中，ASM治疗的12个月保留率为46.7%(7,895/16,904)。和40.0%（4,679/11,688）和40.1%（1,544/3,849）在单一疗法和综合疗法亚组，分别。在治疗的癫痫群亚队列中，526名患者获得了1,029次抢救药物处方，不频繁的补充率（平均1.6-1.9次/年）。在治疗的癫痫群亚队列中，癫痫相关门诊就诊的患者比例较高(89.7%)，其他访问量(71.3%),住院率（25.3%）比单药治疗患者（72.2%，50.2%,19.3%,分别)和综合疗法(83.3%，63.3%,22.8%,分别)子队列。平均（标准差）全因（$114,717[$231,667]）和癫痫相关（$76,134[$204,930]）费用在12个月内，在接受治疗的癫痫发作群亚队列中高于单药治疗（$89,324[$220,181]和$30,745[$145,977]，分别)和综合疗法(101,506美元[152,931美元]和49,383美元[96,285美元]，分别)子队列。
结论：与其他亚组相比，接受癫痫集群治疗的患者发生更高的全因费用和癫痫相关费用以及癫痫相关HCRU，并且很少有抢救药物补充。这项分析的结果强调了对于那些经历癫痫发作集群的癫痫患者需要适当的治疗。新的救援药物改变这些发现的效果将在后续研究中探讨。无论如何,在难治性癫痫和癫痫丛集患者治疗方面具有专业知识的专业提供者可能有助于减轻癫痫丛集的负担.
方法：定义了四个队列：（1）所有癫痫患者（所有癫痫患者）；以及以下子队列：（2）接受单一疗法抗癫痫药物（ASM）的患者；（3）接受ASM综合疗法的患者；（4）接受癫痫发作集群治疗的患者（即，那些服用救援药物和≥1ASM的人)。主要结果是在12个月的随访期内HCRU，进行了描述性分析。
结果：在2017年至2019年之间，16,384例患者被纳入全癫痫队列；11,688例（71.3％）接受单药治疗，3849人（23.5%）接受综合疗法，和526（3.2%）的癫痫发作集群治疗。在所有癫痫队列中，ASM治疗的12个月保留率为46.7%(7,895/16,904)。和40.0%（4,679/11,688）和40.1%（1,544/3,849）在单一疗法和综合疗法亚组，分别。在治疗的癫痫群亚队列中，526名患者获得了1,029次抢救药物处方，不频繁的补充率（平均1.6-1.9次/年）。在治疗的癫痫群亚队列中，癫痫相关门诊就诊的患者比例较高(89.7%)，其他访问量(71.3%),住院率（25.3%）比单药治疗患者（72.2%，50.2%,19.3%,分别)和综合疗法(83.3%，63.3%,22.8%,分别)子队列。平均（标准差）全因（$114,717[$231,667]）和癫痫相关（$76,134[$204,930]）费用在12个月内，在接受治疗的癫痫发作群亚队列中高于单药治疗（$89,324[$220,181]和$30,745[$145,977]，分别)和综合疗法(101,506美元[152,931美元]和49,383美元[96,285美元]，分别)子队列。
结论：与其他亚组相比，接受癫痫集群治疗的患者发生更高的全因费用和癫痫相关费用以及癫痫相关HCRU，并且很少有抢救药物补充。这项分析的结果强调了对于那些经历癫痫发作集群的癫痫患者需要适当的治疗。新的救援药物改变这些发现的效果将在后续研究中探讨。无论如何,在难治性癫痫和癫痫丛集患者治疗方面具有专业知识的专业提供者可能有助于减轻癫痫丛集的负担.
