Healthcare utilization and costs in children with stable and uncontrolled epilepsy

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

doi:10.1016/j.yebeh.2014.01.016

Cited by 81 publications

(75 citation statements)

References 25 publications

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“…32 First-year health care charges did not differ across any other clinical or demographic factors. 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: Resultssupporting

confidence: 93%

“…10 Thus, we aimed to describe the health care utilization patterns and inpatient and outpatient charges in the 12 months following a pediatric epilepsy diagnosis, estimate average annual perpatient health care charges, and identify demographic, clinical, and psychosocial predictors of total health care charges. In line with previous studies, we hypothesized that seizure occurrence, AED nonadherence, and poor HRQOL among youth with newly diagnosed epilepsy would predict increased health care charges in the 12 months postdiagnosis.…”

mentioning

confidence: 99%

“…Univariate analyses examined differences in per-patient health care charges between demographic (e.g., age at diagnosis, sex, insurance status), clinical (e.g., epilepsy etiology, epilepsy type, syndrome presence, AED, seizure since diagnosis), and psychosocial factors (e.g., number of behavioral medicine visits, BASC-2 PRS). Table 1 Descriptive statistics and univariate analysis for total first-year health care charges (n 5 258) Predictors of health care charges, namely demographic and clinical variables significant in previous research (block 1) 10,16,27,30 and psychosocial variables correlated with per-patient charges at the bivariate level (block 2), were examined using hierarchical multiple regression analyses. In the first regression, the outcome variable was total first-year per-patient health care charges.…”

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confidence: 99%

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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: Resultssupporting

confidence: 93%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Health care charges for youth with newly diagnosed epilepsy

et al. 2015

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“…Pediatric epilepsy patients have significant medical costs, 11 and there is significant variation across institutions in how care for these patients is delivered. 12 Some studies have shown that increased education can improve understanding of epilepsy 4 and that lay-education programs can improve health and reduce hospitalizations.…”

Section: Discussionmentioning

confidence: 99%

Seizure Action Plans Do Not Reduce Health Care Utilization in Pediatric Epilepsy Patients

et al. 2015

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Management of pediatric epilepsy requires complex coordination of care. We hypothesized that an improved seizure management care plan would reduce healthcare utilization and improve outcomes. We conducted a cohort study with historical controls of 120 epilepsy patients before and after implementation of a “Seizure Action Plan.” We evaluated for differences in healthcare utilization including emergency department visits, hospitalizations, clinic visits, telephone calls, and the percentage of emergency department visits that resulted in hospitalization in patients who did or did not have a Seizure Action Plan. We found that there was no decrease in these measures of healthcare utilization, and in fact the number of follow-up clinic visits was increased in the group with Seizure Action Plans (4.2 versus 3.3, p 0.006). However, the study was underpowered to detect smaller differences. Our study suggests that pediatric epilepsy quality improvement measures may require alternative approaches to reduce healthcare utilization and improve outcomes.

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“…The burden of epilepsy is devastating and includes social and medical morbidity of the disorder and where epileptic patients are greatly stigmatized and frequently untreated, particularly in developing countries. Epilepsy adversely affects childhood development and could lead to increased economic burden in pediatric populations 8. Hence, the inclusion of Zn supplements into the treatment regimen of pediatric epilepsy is solicited to be economically profitable because it allows to improve the quality of life of epileptic children, minimizes the costs of frequent hospital visits and recurrent hospitalizations, and maintains foreseeable manpower resources.…”

mentioning

confidence: 99%

Serum levels of zinc and copper in epileptic children during long-term therapy with anticonvulsants

Al‐Mendalawi

2016

NSJ

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Healthcare utilization and costs in children with stable and uncontrolled epilepsy

Cited by 81 publications

References 25 publications

Health care charges for youth with newly diagnosed epilepsy

Health care charges for youth with newly diagnosed epilepsy

Seizure Action Plans Do Not Reduce Health Care Utilization in Pediatric Epilepsy Patients

Serum levels of zinc and copper in epileptic children during long-term therapy with anticonvulsants

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