Health-care costs and utilization related to long- or short-acting antiepileptic monotherapy use

Cramer, Joyce A.; Wang, Zhixiao J.; Chang, Eunice; Copher, Ronda; Cherepanov, Dasha; Broder, Michael S.

doi:10.1016/j.yebeh.2014.12.020

Cited by 10 publications

(11 citation statements)

References 21 publications

(26 reference statements)

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“…Seventh, the HCV cohort only included patients with at least two diagnoses of chronic HCV. The practice of requesting two or more diagnoses is common in claims‐based studies . Given that an HCV diagnosis is sometimes recorded when HCV tests are ordered, this criterion was applied to ensure that the HCV cohort did not include HCV‐free patients.…”

Section: Discussionmentioning

confidence: 99%

“…The practice of requesting two or more diagnoses is common in claims-based studies. (17,(26)(27)(28)(29)(30)(31) Given that an HCV diagnosis is sometimes recorded when HCV tests are ordered, this criterion was applied to ensure that the HCV cohort did not include HCV-free patients. While patients with no physician follow-up after their first HCV diagnosis were excluded from the study, individuals who incorrectly received an HCV diagnosis that was subsequently not confirmed were successfully excluded.…”

Section: Reau Et Almentioning

confidence: 99%

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Prevalence and economic burden of extrahepatic manifestations of hepatitis C virus are underestimated but can be improved with therapy

Reau

Vekeman

et al. 2017

Hepatology Communications

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Despite guideline recommendations, access to hepatitis C virus (HCV) treatment is frequently restricted, with some payers approving therapy for only those with advanced disease or cirrhosis. However, delaying potentially curative treatment until the development of advanced liver disease may have costly consequences in terms of both hepatic complications and extrahepatic manifestations (EHMs) of HCV. Using a large claims database from the United States, we measured the risks and medical costs of 20 EHMs and investigated the role of treatment in different stages of liver fibrosis for mitigating the clinical and economic burden of these EHMs. After adjusting for potential confounders, including comorbid liver disease, patients with HCV had a significantly higher risk for any EHM (adjusted odds ratio, 2.23; P < 0.05) and higher EHM‐related annual medical costs (adjusted medical cost difference, $6,458; P < 0.05) compared to matched patients without HCV. HCV treatment can offset the higher medical costs in patients with HCV by saving ∼$25,000 in all‐cause medical costs per patient per year, with a large proportion attributable to savings in EHM‐related medical costs (adjusted cost difference $12,773, P < 0.05). Finally, additional EHM‐related medical costs could be saved by initiating HCV therapy in early stage fibrosis as opposed to late‐stage fibrosis (adjusted medical cost difference, $10,409; P < 0.05). Conclusion: The clinical and economic burden of EHMs is substantial and can be reduced through viral eradication, especially if treatment is initiated early and not delayed until fibrosis advances. Considering that the wholesale acquisition cost of a 12‐week course of therapy ranges from $55,000 to $147,000, the results of the current study suggest the cost of these treatments could be offset within 3 to 6 years by savings in all‐cause medical costs. (Hepatology Communications 2017;1:439–452)

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Section: Discussionmentioning

confidence: 99%

Section: Reau Et Almentioning

confidence: 99%

Prevalence and economic burden of extrahepatic manifestations of hepatitis C virus are underestimated but can be improved with therapy

Reau

Vekeman

et al. 2017

Hepatology Communications

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“…Regardless of the country’s income, the public health burden of epilepsy carries a high risk of disability, economic loss, social isolation, and premature death [4]. Epilepsy is a serious and costly health problem worldwide and includes estimated indirect and direct costs annually of around EUR 15.5 billion in Europe [4] and USD 15.5 billion in the United States [5]. In this regard, the World Health Organization has made this a priority, calling for the development of national healthcare plans for the treatment of epilepsy, not only to ensure the availability of effective care, but also to prevent its causes.…”

Section: Introductionmentioning

confidence: 99%

Ketogenic Diet and Epilepsy

et al. 2019

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Currently available pharmacological treatment of epilepsy has limited effectiveness. In epileptic patients, pharmacological treatment with available anticonvulsants leads to seizure control in <70% of cases. Surgical intervention can lead to control in a selected subset of patients, but still leaves a significant number of patients with uncontrolled seizures. Therefore, in drug-resistant epilepsy, the ketogenic diet proves to be useful. The purpose of this review was to provide a comprehensive overview of what was published about the benefits of ketogenic diet treatment in patients with epilepsy. Clinical data on the benefits of ketogenic diet treatment in terms of clinical symptoms and adverse reactions in patients with epilepsy have been reviewed. Variables that could have influenced the interpretation of the data were also discussed (e.g., gut microbiota). The data in this review contributes to a better understanding of the potential benefits of a ketogenic diet in the treatment of epilepsy and informs scientists, clinicians, and patients—as well as their families and caregivers—about the possibilities of such treatment. Since 1990, the number of publications on attempts to treat drug-resistant epilepsy with a ketogenic diet has grown so rapidly that it has become a challenge to see the overall trajectory and major milestones achieved in this field. In this review, we hope to provide the latest data from randomized clinical trials, practice guidelines, and new research areas over the past 2 years.

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“…Incomplete adherence to treatment has been associated with several clinical and psychosocial determinants. Less education, the presence of psychiatric comorbidities, and poor seizure control have been associated with incomplete adherence 28,34–38. Additionally, stratified adherence grouping suggests that the relationship between seizure control and adherence may not be linear 39.…”

Section: Introductionmentioning

confidence: 99%

Association between addressing antiseizure drug side effects and patient-reported medication adherence in epilepsy

Moura¹,

Carneiro²,

Cole³

et al. 2016

PPA

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Background and aimAdherence to treatment is a critical component of epilepsy management. This study examines whether addressing antiepileptic drug (AED) side effects at every visit is associated with increased patient-reported medication adherence.Patients and methodsThis study identified 243 adults with epilepsy who were seen at two academic outpatient neurology settings and had at least two visits over a 3-year period. Demographic and clinical characteristics were abstracted. Evidence that AED side effects were addressed was measured through 1) phone interview (patient-reported) and 2) medical records abstraction (physician-documented). Medication adherence was assessed using the validated Morisky Medication Adherence Scale-4. Complete adherence was determined as answering “no” to all questions.ResultsSixty-two (25%) patients completed the interviews. Participants and nonparticipants were comparable with respect to demographic and clinical characteristics; however, a smaller proportion of participants had a history of drug-resistant epilepsy than nonparticipants (17.7% vs 30.9%, P=0.04). Among the participants, evidence that AED side effects were addressed was present in 48 (77%) medical records and reported by 51 (82%) patients. Twenty-eight (45%) patients reported complete medication adherence. The most common reason for incomplete adherence was missed medication due to forgetfulness (n=31, 91%). There was no association between addressing AED side effects (neither physician-documented nor patient-reported) and complete medication adherence (P=0.22 and 0.20).Discussion and conclusionAmong patients with epilepsy, addressing medication side effects at every visit does not appear to increase patient-reported medication adherence.

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Health-care costs and utilization related to long- or short-acting antiepileptic monotherapy use

Cited by 10 publications

References 21 publications

Prevalence and economic burden of extrahepatic manifestations of hepatitis C virus are underestimated but can be improved with therapy

Prevalence and economic burden of extrahepatic manifestations of hepatitis C virus are underestimated but can be improved with therapy

Ketogenic Diet and Epilepsy

Association between addressing antiseizure drug side effects and patient-reported medication adherence in epilepsy

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