Impact of nonadherence to antiepileptic drugs on health care utilization and costs: Findings from the RANSOM study

Faught, R. Edward; Weiner, Jennifer; Guérin, Annie; Cunnington, Marianne; Duh, Mei Sheng

doi:10.1111/j.1528-1167.2008.01794.x

Cited by 191 publications

(159 citation statements)

References 23 publications

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“…These findings are consistent with previous studies, 10,11,27 with the exception of medication adherence. 34,35 Discrepant findings are likely due to adherence measurement methods, which were prescription refill data in the adult studies and self or caregiver report, which is known to be inflated, in the current study.…”

Section: Resultsmentioning

confidence: 85%

Health care charges for youth with newly diagnosed epilepsy

et al. 2015

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Objectives: To estimate first-year health care charges for youth with newly diagnosed epilepsy seen within an interdisciplinary pediatric epilepsy team and examine demographic, clinical, and psychosocial predictors of annual charges.Methods: Retrospective chart review was conducted to extract medical, hospital, and physician billing data from the year following an epilepsy diagnosis for 258 patients (aged 2-18 years) seen in a New Onset Seizure Clinic between July 2011 and December 2012. Descriptive statistics were used to estimate per-patient total first-year charges and health care utilization patterns (e.g., hospitalizations, emergency department visits, outpatient visits). Univariate analyses examined differences in health care charges between demographic, clinical, and psychosocial factors. Predictors of health care charges were examined using hierarchical multiple regression analysis. Results:The estimated per-patient total first-year health care charge was $20,084 (95% confidence interval [CI] $16,491-$23,677). Charges were higher for patients who reported having seizures since diagnosis ($25,509; 95% CI $20,162-$30,856) and were associated with more antiepileptic drug side effects (r 5 0.18; 95% CI 0.03-0.32). Controlling for demographic and clinical factors, poorer baseline health-related quality of life was associated with higher perpatient health care charges (B 5 2445.40; 95% CI 2865 to 225). Conclusions:The economic impact of pediatric epilepsy in the year following diagnosis is substantial.Cost reduction efforts would be optimized by improving seizure control and targeting health-related quality of life, an outcome amenable to behavioral intervention. Approximately 20%-40% of youth diagnosed with epilepsy do not successfully respond to antiepileptic drugs (AEDs) 1 and may require more expensive and invasive treatment options (e.g., epilepsy surgery).2 Youth with epilepsy demonstrate greater psychosocial difficulties (e.g., disruptive behavior, depression, medication nonadherence, and poor health-related quality of life [HRQOL]) than youth with other pediatric chronic conditions, 3-6 which can be the result of seizures, AED side effects, or developmental processes.7-9 The physical and psychosocial sequelae likely contribute to the significant economic burden faced by pediatric epilepsy patients. Annual per-patient pediatric epilepsy-related costs range from $522 to $9,713 and are primarily driven by AEDs, clinic visits, and diagnostic procedures.10,11 A large portion of these health care costs are unnecessary/excessive and are incurred in the first year following diagnosis. 12,13 Epilepsy-related factors, including polytherapy, therapeutic drug monitoring, newer AEDs, and seizure control, 10 are often linked to higher health care costs. 11 Psychosocial comorbidities among pediatric patients have also been shown to predict increased health care charges, 14,15 but to our knowledge these have not been examined in pediatric epilepsy. These psychosocial factors are ideal targets for investigation...

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Section: Resultsmentioning

confidence: 85%

Health care charges for youth with newly diagnosed epilepsy

et al. 2015

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“…Non-adherence to AEDs is associated with severe clinical consequences, including increased health care utilisation and increased mortality. 63,64 A relationship has been reported between poor compliance and the risk of seizures whereby every increase in daily dose frequency increased the likelihood of a seizure after a missed dose by 36%. 65 Further, in an analysis of 76 studies reporting compliance measured by electronic monitoring in various disorders, the prescribed number of doses per day was inversely related to compliance: 79% ± 14% if the drug was taken once daily, 69% ± 15% if twice daily, 65% ± 16% if three-times daily, and 51% ± 20% if four-times daily.…”

Section: Adherencementioning

confidence: 99%

Reflections on the Use of Perampanel in Epilepsy – Lessons from the Clinic and Real-world Evidence

Trinka¹,

Carreño²

2017

European Neurological Review

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O ptimal epilepsy management includes five important elements: rational treatment selection, efficacy, off-target effects, adherence and interactions and dosing issues. Perampanel (2-[2-oxo-1-phenyl-5-pyridin-2-yl-1,2-dihydropyridin-3-yl]benzonitrile; E2007) is the first potent, selective, orally-active non-competitive alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist approved for the treatment of patients with epilepsy. Results from randomised controlled trials and real-world studies of refractory epilepsy populations treated with perampanel showed effective frequency reduction for both focal-onset seizures (without and with secondary generalisation) and for primary generalised tonic-clonic seizures. Perampanel therapeutic doses have been calculated to only inhibit a fraction of AMPA receptors, thereby to enable sufficient seizure control without substantial impairment of neurological function. Further investigation in special subpopulations of people with epilepsy, including the elderly and people with learning disability or psychiatric comorbidities, is warranted. With an average long half-life of 105 hours, perampanel may be more forgiving in circumstances of suboptimal adherence. Perampanel is not a strong inducer or inhibitor of cytochrome P450 enzymes, and dose adjustment is not always required for the elderly or for those with mild renal impairment.

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“…VNS therapy has a long-standing association with enhanced QoL. 40 Good adherence to treatment is equally critical and leads to a number of beneficial outcomes, such as improved seizure control, [45][46][47][48] enhanced QoL, 46 lower rate of seizurerelated job loss, 46 hospitalisation and emergency department visits, 4,45,49 lower fracture and motor vehicle accident rates 45,46 and lower mortality rate in adults. 45 VNS therapy has also been associated with reduced healthcare utilisation and costs (see Table 2).…”

mentioning

confidence: 99%

Treating Drug-resistant Epilepsy – Why are we Waiting?

Boon

Ryvlin

Wheless³

et al. 2015

European Neurological Review

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Drug-resistant epilepsy (DRE) has been defined by the ad hoc Task Force of the International League Against Epilepsy (ILAE) Commission on Therapeutic Strategies as the failure of two appropriately chosen and tolerated anti-epileptic drugs (AEDs) (whether as monotherapy or in combination) to control seizures when used for an adequate period of time. The difference between the number of patients with DRE and the number of these patients who do not get access to adequate treatment is defined as the 'treatment gap', which is considered to be substantial.There are multiple possible causes that underlie the treatment gap in DRE: economic costs, natural history of epilepsy, deficiencies in health service provision, social stigma and other as yet unidentified causes. Factors affecting quality of life in DRE include depression and anxiety, raised risk of mortality and morbidity, increased healthcare utilisation and increased risk of adverse events with long-term use of AEDs, cognitive and memory impairment, seizure-related injuries, impaired ability to achieve educational and vocational goals, to drive, establish families and benefit from social relationships. Among the reasons for the greater risk of premature death are the raised risk of suicide in those patients with comorbid psychiatric disease and the increased incidence of sudden unexpected death among those with epilepsy. Managing epilepsy well involves more than just seizure reduction and when freedom from seizures cannot be achieved, addressing quality of life is likely to be more beneficial than interventions aimed at seizure reduction alone. Options exist for patients with DRE who are not candidates for epilepsy surgery, including dietary treatments, further attempts with AEDs and non-pharmacological interventions with devices. Further, non-invasive modalities are emerging, creating a more hopeful picture that the treatment gap for patients with DRE may be narrowed or even closed.

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Impact of nonadherence to antiepileptic drugs on health care utilization and costs: Findings from the RANSOM study

Cited by 191 publications

References 23 publications

Health care charges for youth with newly diagnosed epilepsy

Health care charges for youth with newly diagnosed epilepsy

Reflections on the Use of Perampanel in Epilepsy – Lessons from the Clinic and Real-world Evidence

Treating Drug-resistant Epilepsy – Why are we Waiting?

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