(369) Burden of anti-seizure medication titration on healthcare resource utilization and costs among patients with focal onset seizures: A physician panel-based chart review

Background: : Anti-seizure medications (ASMs), the standard treatment for focal onset seizures (FOS), often require careful titration to improve tolerability, delaying therapeutic dosing and risking suboptimal seizure control. This trade-off may increase healthcare costs due to higher dosing requirements and more frequent monitoring.

Objective: : This study aimed to compare healthcare resource utilization (HRU) and costs between the titration and maintenance periods of ASM treatments among patients with FOS in the United States (US).

Methods: : A retrospective physician panel-based chart review completed by neurologists and epileptologists was used to collect data on adult patients with FOS initiating an ASM between 1/1/2021 and 12/31/2023 (index date). Epilepsy-related HRU and costs were assessed from the index date to the earliest of index ASM discontinuation, loss-to-follow-up, or end of data collection. Based on reported HRU, costs were imputed using literature-based estimates of epilepsy-related costs in the US. Physician-evaluated titration end date was used to divide follow-up time into titration and maintenance periods. Multivariate regression models adjusting for patient characteristics observed during the 6-month period pre-ASM initiation (baseline period) were used to compare HRU and costs between titration and maintenance periods.

Results: : Overall, 148 neurologists/epileptologists provided data on 399 patients (mean age: 36.5 years, 60.7% male, 69.2% white, 70.2% commercially insured). The median duration of the titration and maintenance periods was 3.1 and 16.0 months, respectively. Per-patient-month (PPM) HRU was significantly higher in the titration versus maintenance period for all HRU types: inpatient admissions (adjusted incidence rate ratio [IRR]: 5.70), emergency room (ER) visits (IRR: 3.39), outpatient visits (IRR: 1.52), lab monitoring (IRR: 1.89), diagnostic services (IRR: 3.24) and office phone calls (IRR: 2.52; all p< 0.001). PPM healthcare costs were also significantly higher during the titration versus maintenance period (adjusted total mean monthly cost difference: $879; inpatient: $717; ER: $98; outpatient: $37; lab monitoring: $1; diagnostics: $20; all p< 0.001).

Conclusions: : Among patients with FOS, epilepsy-related HRU was 1.5-6 times higher during titration than maintenance periods. Epilepsy-related costs were also higher during titration, driven by higher inpatient and ER costs. Safe, efficacious treatments that avoid prolonged titration periods may help reduce titration-related HRU and costs for patients with FOS.

Sponsorship:: Xenon Pharmaceuticals Inc.