(387) A Propensity Score-Matched Analysis of Healthcare Utilization and Cost in Medicaid Beneficiaries with Epilepsy

Background: : Epilepsy (EPI) is a chronic recurring neurological condition characterized by unprovoked seizures that affects approximately 1.1% of adults in the U.S. (1). The PPPY economic burden associated with EPI is significant, with EPI-related medical costs ranging from $1,022 - $19,749 (2). Use of rescue medications can reduce EPI-related medical costs to patients (3). It has been reported that large gaps in treatment exist in patients with epilepsy covered under Medicaid insurance and that EPI-related costs are high among some epilepsy patients (4, 5).

Objective: : This study aims to better understand the healthcare and economic burden of epilepsy among Medicaid patients utilizing rescue medications.

Methods: : A retrospective claims analysis was conducted using the STATinMED RWD Insights database. Patients (≥2 years) with ≥1 inpatient or outpatient EPI/convulsion diagnosis (ICD-10 G40*, R56*) between July 1, 2020, and October 31, 2023, were included. Eligibility required ≥80% adherence to anti-seizure medications (ASMs) via PDC, ≥6 months of continuous data pre- and post-index, a 6-month EPI/convulsion-free baseline, and Medicaid coverage at index (first ASM fill). Propensity score matching was performed on mean QCI, age, and sex. Annual healthcare resource utilization (HCRU) and costs were assessed for matched cohorts, costs were average monthly costs over the follow-up period.

Results: : 33,846 patients were prescribed rescue medications (RM) and 48,703 were not. RM patients were younger (mean age 40 vs. 42), had higher QCI scores (1.3 vs. 0.8), more frequent diagnoses of depression (16.8% vs. 12%) and anxiety (20.1% vs. 13%). Both groups were majority male and white (43.5%, 42.7%). In EPI-related HCRU, RM users had ≥1 IP visit (56.6% vs. 37.5%, p< 0.001) and ≥1 ER visit (44.4% vs. 36.3%, p< 0.001). Mean IP length of stay (2.76 vs. 2.25 days) was also higher among RM users (p < 0.001). Readmission within 7 days was also elevated among RM users (30-day: 17.5% vs. 11.6%, p< 0.001). RM patients had double the total cost ($10,064 vs. $4,682; p< 0.001), with higher IP ($9,150 vs. $4,150), ER ($104 vs. $53) (all p< 0.001) and pharmacy costs ($3,634 vs. $2,873; p=0.008).

Conclusions: : ASM-adherent Medicaid patients prescribed RM had higher HCRU and costs compared to patients who were not. This suggests patients utilizing RM have more severe or uncontrolled EPI. PSM enabled the comparison of similar patients across cohorts to maintain accuracy of results. Further research comparing specific RM would assist in determining which treatments to recommend while stabilizing a patient’s epileptic status.

Sponsorship:: STATinMED, LLC.