Adherence to antiepileptic drugs among diverse older Americans on Part D Medicare

Piper, Kendra; Richman, Joshua S.; Faught, Edward; Martin, Roy C.; Funkhouser, Ellen; Szaflarski, Jerzy P.; Dai, Chen; Juarez, Lucia; Pisu, Maria

doi:10.1016/j.yebeh.2016.10.017

Cited by 24 publications

(35 citation statements)

References 26 publications

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“…Moreover, because of our research question, our cohort over-represented minority groups compared to a random sample of Medicare beneficiaries meeting similar inclusion criteria. 38 …”

Section: Discussionmentioning

confidence: 99%

Quality of Antiepileptic Treatment Among Older Medicare Beneficiaries With Epilepsy

et al. 2017

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Background Enzyme-inducing anti-epileptic drugs (EI-AEDs) are not recommended for older adults with epilepsy. Quality Indicator for Epilepsy Treatment 9 (QUIET-9) states that new patients should not receive EI-AEDs as first line of treatment. In light of reported racial/ethnic disparities in epilepsy care, we investigated EI-AED use and QUIET-9 concordance across major racial/ethnic groups of Medicare beneficiaries. Research Design Retrospective analyses of 2008–2010 Medicare claims for a 5% random sample of beneficiaries ≥67 years old in 2009 augmented for minority representation. Logistic regressions examined QUIET-9 concordance differences by race/ethnicity adjusting for individual, socioeconomic, and geography factors. Subjects Epilepsy prevalent (≥1 ICD-9 345.× or ≥2 ICD-9 780.3×, ≥1 AED), and new (same as prevalent + no seizure/epilepsy events nor AEDs in 365 days before index event) cases. Measures Use of EI-AEDs and QUIET-9 concordance (no EI-AEDs for first two AEDs) Results Cases were 21% White, 58% African American (AA), 12% Hispanic, 6% Asian, 2% American Indian/Alaskan Native (AI/AN). About 65% of prevalent, 43.6% of new cases, used EI-AEDs. QUIET-9 concordance was found for 71% Asian, 65% White, 61% Hispanic, 57% AA, 55% AI/AN new cases: racial/ethnic differences were not significant in adjusted model. Beneficiaries without neurology care, in deductible drug benefit phase, or in high poverty areas were less likely to have QUIET-9 concordant care. Conclusions EI-AED use is high, and concordance with recommendations low, among all racial/ethnic groups of older adults with epilepsy. Potential socioeconomic disparities and drug coverage plans may affect treatment quality and opportunities to live well with epilepsy.

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“…Moreover, because of our research question, our cohort over-represented minority groups compared to a random sample of Medicare beneficiaries meeting similar inclusion criteria. 38 …”

Section: Discussionmentioning

confidence: 99%

Quality of Antiepileptic Treatment Among Older Medicare Beneficiaries With Epilepsy

et al. 2017

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“…The PDC is the ratio of the number of days with at least one AED prescription over the total number of days from the first AED prescription to the end of the last refilled prescription or to the end of follow‐up (whichever comes first). About 32% of cases had a PDC < 80%; Care concordant with Quality Indicators for Epilepsy Treatment (QUIET) 15, that is, whether adjustments to AEDs were made following a seizure. Among beneficiaries with a seizure for which an emergency room (ER) visit occurred (n = 4132), 50% had AED changes and care concordant with QUIET 15; Care concordant with QUIET 6 for new cases, that is, starting AED treatment with monotherapy (>90%); Care concordant with QUIET 9 for new cases, that is, at least two non–enzyme‐inducing AEDs tried before starting enzyme‐inducing drugs (about 60%); and, Presence of drug interaction risk (care not concordant with QUIET 11) for new cases (about 25%) …”

Section: Methodsmentioning

confidence: 99%

“…Among older Americans with epilepsy, about 1.5% of older adults, minority groups may be at risk of high costs of care. Recent studies have found that African Americans, for example, have poor adherence to antiepileptic drugs (AEDs) and are more likely to have seizures resulting in emergency room visits . As shown in younger populations with epilepsy, these factors may lead to higher costs of care as well as poor health status .…”

Section: Introductionmentioning

confidence: 99%

“…In addition, in line with other studies that have shown higher costs after an epilepsy index event, we compared costs in the follow‐up period to costs in the year before to determine whether the same pattern is present in the older population. We used claims data for a cohort of Medicare beneficiaries with epilepsy that overrepresents minority groups …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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.

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“…The higher price of innovator AEDs may actually decrease adherence, although this has not been studied explicitly. Among elderly patients in the United States, those living in high‐poverty postal codes or in deductible drug benefit insurance phases were more likely to be nonadherent than those in more affluent areas or cost‐sharing insurance phases . In Sweden, higher income and lower copayment increased AED refill adherence …”

Section: Clinical Studiesmentioning

confidence: 99%

Generic antiepileptic drugs—Safe or harmful in patients with epilepsy?

Holtkamp

Theodore

2018

Epilepsia

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Summary Generic antiepileptic drugs (AED) are significantly cheaper than brand name drugs, and may reduce overall health care expenditures. Regulatory bodies in Europe and North America require bioequivalence between generic and innovator drugs with regard to area under the plasma concentration–time curve (AUC) and peak plasma concentration (Cmax); strict cutoff values have been defined. The main issue is if bioequivalence ensures therapeutic equivalence. Are switches from brand to generic, or between generic AEDs entirely safe or potentially harmful in patients with epilepsy? We summarized and evaluated the available evidence from bioequivalence, health care utilization, and clinical studies on safety of generic AEDs. In most cases, variations in AUC and Cmax were negligible when comparing innovator and generic AEDs. Due to interindividual pharmacokinetic and pharmacodynamic variability, measured differences between innovator and generic drugs may be the same as differences between different lots of the same brand. Studies from several countries based on insurance data have reported an increase in health care usage after switch from brand to generic AEDs; switchback rates are significantly higher for AEDs compared to other compounds. Patients may be confused, and nonadherence may increase, when AEDs are switched between manufacturers, perhaps due to changes in medication shape and color. But clinical studies do not report changes in seizure frequency and tolerability attributable to generics. Sufficient evidence indicates that most generics are bioequivalent to innovator AEDs; they do not pose a relevant risk for patients with epilepsy. However, some patients are reluctant towards variations in color and shape of their AEDs which may result in nonadherence. We recommend administering generics when a new AED is initiated. Switches from brand to generic AEDs for cost reduction and between generics, which is rarely required, generally seem to be safe, but should be accompanied by thorough counseling of patients on low risks.

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Adherence to antiepileptic drugs among diverse older Americans on Part D Medicare

Cited by 24 publications

References 26 publications

Quality of Antiepileptic Treatment Among Older Medicare Beneficiaries With Epilepsy

Quality of Antiepileptic Treatment Among Older Medicare Beneficiaries With Epilepsy

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

Generic antiepileptic drugs—Safe or harmful in patients with epilepsy?

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