High health care costs in minority groups of older US Medicare beneficiaries with epilepsy

• Type of Material: Article
• Authors: Maria Pisu, University of Alabama Birmingham; Joshua Richman, University of Alabama Birmingham; Jerzy P. Szaflarski, University of Alabama Birmingham; Ellen Funkhouser, University of Alabama Birmingham; Chen Dai, University of Kentucky; Lucia Juarez, University of Alabama Birmingham; Raymond Faught Jr, Emory University; Roy C. Martin, University of Alabama Birmingham
• Language: English
• Date: 2019-07-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 John Wiley & Sons, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1111/epi.16051
• Title of Journal or Parent Work: Epilepsia
• Volume: 60
• Issue: 7
• Start Page: 1462
• End Page: 1471
• Grant/Funding Information: The study was funded by the National Institute of Neurological Disease and Stroke (1RO1NS080898–01, Maria Pisu, Principal Investigator).
• Keywords: Adults; Life Sciences & Biomedicine; Prevalence; quality of care; Impact; Neurosciences & Neurology; Seizures; older adults; seizure; epilepsy; costs; Clinical comorbidity; Risk; Science & Technology; Medicare; Nonadherence; Clinical Neurology; Quality; Antiepileptic drugs
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management; Biology, Neuroscience

Abstract

Objective: To examine health care costs in diverse older Medicare beneficiaries with epilepsy. Methods: Using 2008–2010 claims data, we conducted a longitudinal cohort study of a random sample of Medicare beneficiaries augmented for minority representation. Epilepsy cases (n = 36 912) had ≥1 International Classification of Diseases, Ninth Edition (ICD-9) 345.x or ≥2 ICD-9 780.3x claims, and ≥1 antiepileptic drug (AED) in 2009; new cases (n = 3706) had no seizure/epilepsy claims nor AEDs in the previous 365 days. Costs were measured by reimbursements for all care received. High cost was defined as follow-up 1-year cost ≥ 75th percentile. Logistic regressions examined association of high cost with race/ethnicity, adjusting for demographic, clinical, economic, and treatment quality factors. In cases with continuous 2-year data, we obtained costs in two 6-month periods before and two after the index event. Results: Cohort was ~62% African Americans (AAs), 11% Hispanics, 5% Asians, and 2% American Indian/Alaska Natives. Mean costs in the follow-up were ~$30 000 (median = $11 547; new cases, mean = $44 642; median = $25 008). About 19% white compared to 27% AA cases had high cost. AA had higher odds of high cost in adjusted analyses (odds ratio [OR] = 1.20, 95% confidence interval [CI] = 1.11–1.29), although this was only marginally significant when adjusting for AED adherence (OR = 1.09, 95% CI = 1.01–1.18, P = 0.03). Factors associated with high cost included ≥1 comorbidity, neurological care, and low AED adherence. Costs were highest at ~$17 000 in the 6 months immediately before and after the index event (>$29 000 for new cases). Significance: The financial sequelae of epilepsy among older Americans disproportionally affect minorities. Studies should examine contributors to high costs.