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What does the U.S. Medicare administrative claims database tell us about initial antiepileptic drug treatment for older adults with new‐onset epilepsy?
Author(s) -
Martin Roy C.,
Faught Edward,
Szaflarski Jerzy P.,
Richman Joshua,
Funkhouser Ellen,
Piper Kendra,
Juarez Lucia,
Dai Chen,
Pisu Maria
Publication year - 2017
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13675
Subject(s) - medicine , epilepsy , diagnosis code , levetiracetam , population , concordance , pediatrics , retrospective cohort study , medicaid , ethnic group , logistic regression , prescription drug , medical prescription , demography , psychiatry , health care , anthropology , economics , economic growth , environmental health , pharmacology , sociology
Summary Objective Disparities in epilepsy treatment are not uncommon; therefore, we examined population‐based estimates of initial antiepileptic drugs ( AED s) in new‐onset epilepsy among racial/ethnic minority groups of older US Medicare beneficiaries. Methods We conducted retrospective analyses of 2008–2010 Medicare administrative claims for a 5% random sample of beneficiaries augmented for minority representation. New‐onset epilepsy cases in 2009 had ≥1 International Classification of Diseases, Ninth Revision ( ICD ‐9) 345.x or ≥2 ICD ‐9 780.3x, and ≥1 AED , AND no seizure/epilepsy claim codes or AED s in preceding 365 days. We examined AED use and concordance with Quality Indicators of Epilepsy Treatment ( QUIET ) 6 (monotherapy as initial treatment = ≥30 day first prescription with no other concomitant AED s), and prompt AED treatment (first AED within 30 days of diagnosis). Logistic regression examined likelihood of prompt treatment by demographic (race/ethnicity, gender, age), clinical (number of comorbid conditions, neurology care, index event occurring in the emergency room (ER)), and economic (Part D coverage phase, eligibility for Part D Low Income Subsidy [ LIS ], and ZIP code level poverty) factors. Results Over 1 year of follow‐up, 79.6% of 3,706 new epilepsy cases had one AED only (77.89% of whites vs. 89% of American Indian/Alaska Native [ AI / AN ]). Levetiracetam was the most commonly prescribed AED (45.5%: from 24.6% AI / AN to 55.0% whites). The second most common was phenytoin (30.6%: from 18.8% Asians to 43.1% AI / AN ). QUIET 6 concordance was 94.7% (93.9% for whites to 97.3% of AI / AN ). Only 50% received prompt AED therapy (49.6% whites to 53.9% AI / AN ). Race/ethnicity was not significantly associated with AED patterns, monotherapy use, or prompt treatment. Significance Monotherapy is common across all racial/ethnic groups of older adults with new‐onset epilepsy, older AED s are commonly prescribed, and treatment is frequently delayed. Further studies on reasons for treatment delays are warranted. Interventions should be developed and tested to develop paradigms that lead to better care.