and yHenry Ford Hospital, Detroit, Michigan, U.S.A. SUMMARYPurpose: Although antiepileptic drugs (AEDs) with multisource generic alternatives are becoming more prevalent, no case-control studies have been published examining multisource medication use and epilepsy-related outcomes. This study evaluated the association between inpatient/emergency epilepsy care and the occurrence of a recent switch in AED formulation. Methods: A case-control analysis was conducted utilizing the Ingenix LabRx Database. Eligible patients were 12-64 years of age, received ‡145 days of AEDs in the preindex period, had continuous eligibility for 6 months preindex, and no prior inpatient/emergency care. Cases received care between 7/1/2006 and 12/31/2006 in an ambulance, emergency room, or inpatient hospital with a primary epilepsy diagnosis. Controls had a primary epilepsy diagnosis in a physician's office during the same period. The index date was the earliest occurrence of care in each respective setting.Cases and controls were matched 1:3 by epilepsy diagnosis and age. Odds of a switch between ''A-rated'' AEDs within 6 months prior to index were calculated. Results: Cases (n ¼ 416) had 81% greater odds of having had an A-rated AED formulation switch [odds ratio (OR) ¼ 1.81; 95% confidence interval (CI) ¼ 1.25 to 2.63] relative to controls (n ¼ 1248). There were no significant differences between groups regarding demographics or diagnosis. Significant differences were found with regard to medical coverage type (case Medicaid ¼ 4.6%, control Medicaid ¼ 1.8%, p ¼ 0.002). Post hoc analysis results excluding Medicaid recipients remained significant and concordant with the original analysis. Discussion: This analysis found an association between patients receiving epilepsy care in an emergency or inpatient setting and the recent occurrence of AED formulation switching involving A-rated generics.

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