High health care costs in minority groups of older US Medicare beneficiaries with epilepsy

Abstract

Objective To examine health care costs in diverse older Medicare beneficiaries with epilepsy. Methods Using 2008‐2010 claims data, we conducted a longitudinal cohort study of a random sample of Medicare beneficiaries augmented for minority representation. Epilepsy cases (n = 36 912) had ≥1 International Classification of Diseases, Ninth Edition (ICD‐9) 345.x or ≥2 ICD‐9 780.3x claims, and ≥1 antiepileptic drug (AED) in 2009; new cases (n = 3706) had no seizure/epilepsy claims nor AEDs in the previous 365 days. Costs were measured by reimbursements for all care received. High cost was defined as follow‐up 1‐year cost ≥ 75th percentile. Logistic regressions examined association of high cost with race/ethnicity, adjusting for demographic, clinical, economic, and treatment quality factors. In cases with continuous 2‐year data, we obtained costs in two 6‐month periods before and two after the index event. Results Cohort was ~62% African Americans (AAs), 11% Hispanics, 5% Asians, and 2% American Indian/Alaska Natives. Mean costs in the follow‐up were ~$30 000 (median = $11 547; new cases, mean = $44 642; median = $25 008). About 19% white compared to 27% AA cases had high cost. AA had higher odds of high cost in adjusted analyses (odds ratio [OR] = 1.20, 95% confidence interval [CI] = 1.11‐1.29), although this was only marginally significant when adjusting for AED adherence (OR = 1.09, 95% CI = 1.01‐1.18, P = 0.03). Factors associated with high cost included ≥1 comorbidity, neurological care, and low AED adherence. Costs were highest at ~$17 000 in the 6 months immediately before and after the index event (>$29 000 for new cases). Significance The financial sequelae of epilepsy among older Americans disproportionally affect minorities. Studies should examine contributors to high costs.

Delays and disparities in diagnosis for adults with epilepsy: Findings from U.S. Medicaid data

“…Racial/ethnic disparities are known in epilepsy care, such as receiving surgery, in epilepsy costs, and possibly in epilepsy prevalence. [23][24][25][26][27][28][29][30][31] However, this is the first study we know of to clearly demonstrate racial/ethnic disparities in care pathways and the time to diagnosis. This meaningfully contributes to the epilepsy literature by heightening awareness of the need to understand the full-scope of disparities and providing details about the great variation and disparities that exist even in the most basic of situations, in this case care pathways.…”

Accuracy of ICD-10-CM claims-based definitions for epilepsy and seizure type

“…Currently, the most powerful tool for population-based research is the use of large administrative claims datasets, which can include diagnosis codes recorded after a clinical encounter for internal administrative purposes or codes billed for health insurance (Jette et al, 2010a). These data are increasingly used to obtain population-level estimates of incidence and prevalence (Faught et al, 2012;Helmers et al, 2015;Jette et al, 2010a), measure financial burden (Begley and Durgin, 2015;Pisu et al, 2019), and measure the value of health care provided to people with epilepsy (AHRQ, 2019;Burneo et al, 2016;Hill et al, 2019). Claims data overcome many methodological challenges by enabling systematic collection at both the regional and national levels (Thurman et al, 2011).…”