Prevalence and cost of nonadherence to antiepileptic drugs in elderly patients with epilepsy

Ettinger, Alan B.; Manjunath, Ranjani; Candrilli, Sean; Davis, Keith L.

doi:10.1016/j.yebeh.2008.10.021

Cited by 118 publications

(123 citation statements)

References 21 publications

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“…Polypharmacy is extremely common in elderly epilepsy patients, and leads to non-adherence to AEDs among more than 40% of this patient group 64 . Non-compliance of AEDs causes increased cost and hospitalization, risk of injury, and triples the mortality risk 65 .…”

Section: Drugedrug Interactions and Comorbiditiesmentioning

confidence: 99%

Epilepsy in the Elderly

Chen

Cheng

Jou

2012

International Journal of Gerontology

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s u m m a r y Elderly people are the largest and continuously fastest growing population among patients with epilepsy. Elderly patients with epilepsy are very different from other age groups in many respects and clinicians shouldn't treat them in the same way as younger adults. Accurate diagnosis of epilepsy in the elderly is much more difficult and atypical manifestations and misdiagnoses are certainly not the exception. Syncope is probably the most important differential diagnosis. High clinical suspicion and proper investigation are the best tools for prompt diagnosis. Etiologies of late-onset epilepsy are mainly symptomatic and cerebrovascular diseases are the most common causes in this age group, followed by degenerative diseases such as Alzheimer's disease. It is appropriate to consider starting antiepileptic drug (AED) treatment at the first-ever seizure in elderly patients who have remote symptomatic causes such as stroke and dementia. According to the high recurrence rate of seizure and the good response to AEDs in elderly patients, the proper choice from various AEDs for seizure control is very important. Decisionmaking for AED choice depends on many different factors, including pharmacological properties, efficacy, tolerability from side effects, drug interactions, and medical comorbidities. The newer AEDs with lesser adverse effects and fewer drug interactions appear to be reasonable treatment options for elderly patients. However, more evidence from clinical trials in this specific age group is warranted.

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Section: Drugedrug Interactions and Comorbiditiesmentioning

confidence: 99%

Epilepsy in the Elderly

Chen

Cheng

Jou

2012

International Journal of Gerontology

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“…(3) It is well established that patients with suboptimal adherence levels are more likely to have seizures that are associated with increased number of hospital admissions and healthcare costs. (4) Factors influencing adherence to AEDs have been described; these include patient-, treatment-and health system-related factors. (5) The promotion of medication adherence is considered to be an important component of pharmaceutical care practice.…”

Section: Introductionmentioning

confidence: 99%

An evaluation of factors affecting adherence to antiepileptic drugs in patients with epilepsy: a cross-sectional study

Gurumurthy

Kulkarni

Sarma

2017

smedj

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INTRODUCTIONEpilepsy affects 70 million people worldwide.(1) Long-term antiepileptic drug (AED) administration remains the mainstay of epilepsy treatment. In up to 67% of patients with epilepsy (PWE), AEDs effectively eliminate or reduce the frequency of seizures.(2) Medication adherence refers to the extent to which a patient's behaviour corresponds with the recommendations of a health professional. Medication adherence is usually better when there is greater patient involvement in the treatment choice, as well as cooperation and mutual agreement between the health provider and the patient.(2) Nonadherence rates among PWE are reported to be 30%-50%.(3) It is well established that patients with suboptimal adherence levels are more likely to have seizures that are associated with increased number of hospital admissions and healthcare costs.(4) Factors influencing adherence to AEDs have been described; these include patient-, treatment-and health system-related factors.(5) The promotion of medication adherence is considered to be an important component of pharmaceutical care practice. Several methods have been used to measure therapeutic adherence, including self-report, pill count, appointment attendance, medication refill history, blood or urine drug levels and drug diary.(6) Indirect methods, such as self-reports and patient interviews, are the simplest and most common methods used for measuring medication adherence. (7,8) To date, most of the studies conducted to evaluate AED adherence among PWE did not account for the influence of a wide range of variables (e.g. demographic, disease and treatment patterns). There are not many studies in the Indian literature that examine the factors that influence AED adherence. Identifying the factors associated with AED adherence would allow the development of strategies to improve adherence. Thus, the present study aimed to evaluate the pattern and extent of AED adherence among PWE and to identify the factors that influence adherence. METHODSThis cross-sectional study was conducted by the Division of Clinical Pharmacology at the outpatient and inpatient clinics of the Department of Neurology, St John's Medical College and Hospital, Bangalore, India, over a period of 1.5 years (January 2012 to July 2013). Ethical approval was obtained from the institution's Ethical Review Board. Patients aged ≥ 18 years who were receiving AED treatment were eligible for inclusion in the study. Only those who gave their consent for participation were enrolled. Pregnant or lactating women and patients with comorbidities were excluded from the study.Data was collected using a specially designed case record form that included items on demographic/family history, seizure history, duration of epilepsy, AEDs prescribed and occurrence of

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“…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: Resultsmentioning

confidence: 64%

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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Prevalence and cost of nonadherence to antiepileptic drugs in elderly patients with epilepsy

Cited by 118 publications

References 21 publications

Epilepsy in the Elderly

Epilepsy in the Elderly

An evaluation of factors affecting adherence to antiepileptic drugs in patients with epilepsy: a cross-sectional study

Health care charges for youth with newly diagnosed epilepsy

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