Newer antiepileptic drug use and other factors decreasing hospital encounters

Faught, Edward; Helmers, Sandra L.; Begley, Charles E.; Thurman, David J.; Dilley, Cynthia; Clark, C.; Fritz, Patty

doi:10.1016/j.yebeh.2015.01.039

Cited by 17 publications

(20 citation statements)

References 27 publications

(34 reference statements)

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“…Finally, this study does not address the question of how addition of perampanel compares to addition of other antiepileptic drugs or initiation of other therapies in reduction of health care utilization. There is some evidence that “active management”—that is, making some change in therapy—reduces subsequent hospitalizations and emergency visits for epilepsy in comparison with no change at all in therapy . One could also argue that epilepsy is a variable disease, that new drugs are likely to be initiated when it is more severe, and that a regression toward a mean of less severity may occur.…”

Section: Discussionmentioning

confidence: 99%

“…There is some evidence that "active management"-that is, making some change in therapy-reduces subsequent hospitalizations and emergency visits for epilepsy in comparison with no change at all in therapy. 30 One could also argue that epilepsy is a variable disease, that new drugs are likely to be initiated when it is more severe, and that a regression toward a mean of less severity may occur. However, the consistent and dramatic improvement after perampanel suggests a therapeutic effect, not a random variation.…”

Section: Figurementioning

confidence: 99%

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Health care resource utilization before and after perampanel initiation among patients with epilepsy in the United States

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Health care resource utilization before and after perampanel initiation among patients with epilepsy in the United States

et al. 2017

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“…There is evidence to suggest that access to newer AEDs and epilepsy specialists can result in improved seizure control . Data from the USA showed that use of second‐generation AEDs decreased epilepsy‐related hospital admissions compared with first‐generation AEDs (relative risk reduction = 31%; P < 0.01) and had a greater impact on epilepsy‐related hospital encounters of the sickest patients with more comorbidities . Interestingly, neurologists prescribed second‐generation AEDs more often than primary care physicians did .…”

Section: Psychosocial Diagnostic and Treatment Challengesmentioning

confidence: 99%

“…Data from the USA showed that use of second‐generation AEDs decreased epilepsy‐related hospital admissions compared with first‐generation AEDs (relative risk reduction = 31%; P < 0.01) and had a greater impact on epilepsy‐related hospital encounters of the sickest patients with more comorbidities . Interestingly, neurologists prescribed second‐generation AEDs more often than primary care physicians did . Studies from Asia show that the older drugs such as carbamazepine and valproic acid are still more commonly prescribed than second‐generation AEDs, although the use of newer AEDs is increasing in some areas …”

Section: Psychosocial Diagnostic and Treatment Challengesmentioning

confidence: 99%

Epilepsy in Asia: Disease burden, management barriers, and challenges

et al. 2018

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This article reviews the burden of epilepsy in Asia, the challenges faced by people with epilepsy, and the management of epilepsy. Comparison is made with other parts of the world. For this narrative review, data were collected using specified search criteria. Articles investigating the epidemiology of epilepsy, diagnosis, comorbidities and associated mortality, stigmatization, and treatment were included. Epilepsy is a global health care issue affecting up to 70 million people worldwide. Nearly 80% of people with epilepsy live in low- and middle-income countries with limited resources. People with epilepsy are prone to physical and psychological comorbidities, including anxiety and depression, which can negatively impact their quality of life. Furthermore, people with epilepsy are at higher risk of premature death than people without epilepsy. Discrimination or stigmatization of people with epilepsy is common in Asia and can affect their education, work, and marriage opportunities. Access to epilepsy treatment varies throughout Asia. Although highly advanced treatment is available in some countries, up to 90% of people with epilepsy are not adequately treated or are not treated with conventional antiepileptic therapy in resource-limited countries. People in remote areas often do not receive any epilepsy care. First-generation antiepileptic drugs (AEDs) are available, but usually only in urban areas, and second-generation AEDs are not available in all countries. Newer AEDs tend to have more favorable safety profiles than first-generation AEDs and provide options to tailor therapy for individual patients, especially those with comorbidities. Active epilepsy surgery centers are present in some countries, although epilepsy surgery is often underutilized given the number of patients who could benefit. Further epidemiologic research is needed to provide accurate epilepsy data across the Asian region. Coordinated action is warranted to improve access to treatment and care.

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“…The importance of this continued care indicator is underscored by the results of recent analyses revealing significantly less adherence to QUIET-15 in a primary care setting as compared to neurology-only care or shared (PCP & neurology) care (2), better outcome with epilepsy subspecialty care (3), and continued suboptimal access to care for patients with epilepsy within the first year after occurrence of recent seizures as assessed by the National Health Interview Survey (NHIS) (4). In addition, a recent examination of two insurance databases (commercial and federal) found longer times between hospitalization for recurrent seizures in beneficiaries who received change in AEDs (preferably to a second-generation AED) and received neurology treatment (5). …”

Section: Introductionmentioning

confidence: 99%

Quality Indicator for Epilepsy Treatment 15 (QUIET-15): Intervening after recurrent seizures in the elderly

Szaflarski

Martin

Faught

et al. 2017

Epilepsy & Behavior

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In this study, we examined the provision of care to older adults with epilepsy and compliance with the “Quality Indicator for Epilepsy Treatment 15” (QUIET-15) measure. We analyzed 2008–2010, 5% random sample of Medicare beneficiaries augmented with data from all beneficiaries who identified as a minority with claims related to seizures (780.3x) or epilepsy (345.xx). Of 36,912 identified epilepsy cases, 12.6% had ≥1 emergency room (ER) visit for seizure(s). For those who presented to ER, among those taking anti-epileptic drugs (AEDs), AED was changed in 15.4%, dose adjusted in 19.7%, and stopped in 14.9%; among those not taking AED, therapy was initiated in 68.5%. In adjusted logistic regressions, African-Americans were more likely to have recurrent seizures than Whites (OR 1.41, 95%CI 1.27–1.56), while Asians were less likely to have recurrent seizures (OR 0.71, 95%CI 0.57–0.89). There were no significant racial/ethnic differences in the likelihood of a post-seizure intervention. The chance of seizure recurrence leading to ER visit decreased with age and increased with the number of comorbidities. Patients with seizure recurrence were more likely to be taking an enzyme-inducing AED (OR 1.69, 95%CI 1.57–1.82) and receiving Part D Low Income Subsidy (OR 1.36, 95%CI 1.22–1.51). The probability of AED change after a seizure was higher for patients with ≥4 comorbidities (OR 1.69, 95%CI 1.25–2.27), patients who saw a neurologist (OR 1.49, 95%CI 1.30–1.70), and patients who were taking an enzyme-inducing AED (OR 1.47, 95%CI 1.27–1.71). Overall, a minority of Medicare beneficiaries experienced seizure recurrence that resulted in an ER visit. However, only half of them received treatment concordant with QUIET-15. Though racial differences were observed in occurrence of seizures, none were noted in the provision of care.

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Newer antiepileptic drug use and other factors decreasing hospital encounters

Cited by 17 publications

References 27 publications

Health care resource utilization before and after perampanel initiation among patients with epilepsy in the United States

Health care resource utilization before and after perampanel initiation among patients with epilepsy in the United States

Epilepsy in Asia: Disease burden, management barriers, and challenges

Quality Indicator for Epilepsy Treatment 15 (QUIET-15): Intervening after recurrent seizures in the elderly

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