Quality of Antiepileptic Treatment Among Older Medicare Beneficiaries With Epilepsy A Retrospective Claims Data Analysis

• Type of Material: Article
• Authors: M Pisu, University of Alabama Birmingham; J Richman, University of Alabama Birmingham; LaKendra Piper, Emory University; R Martin, University of Alabama Birmingham; E Funkhouser, University of Alabama Birmingham; C Dai, University of Alabama Birmingham; L Juarez, University of Alabama Birmingham; JP Szaflarski, University of Alabama Birmingham; Edward Faught Jr, Emory University
• Language: English
• Date: 2017-07-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/MLR.0000000000000724
• Title of Journal or Parent Work: Medical Care
• ISSN: 0025-7079
• Volume: 55
• Issue: 7
• Start Page: 677
• End Page: 683
• Grant/Funding Information: Dr. Szaflarski received funding from UCB Biosciences, Compumedics Neuroscan Inc., SAGE Therapeutics Inc.; had consulting activity for SAGE Therapeutics Inc., Biomedical Systems Inc., Elite Medical Experts LLC; The authors are grateful for support from the National Institute of Neurological Disorders and Stroke (1R01NS080898-01).
• Keywords: Public, Environmental & Occupational Health; enzyme-inducing drugs; INTERNATIONAL LEAGUE; HEALTH-CARE UTILIZATION; Medicare; Science & Technology; epilepsy; Health Policy & Services; DRUG; CLINICAL COMORBIDITY INDEX; Life Sciences & Biomedicine; administrative claims; PART D; Medicare part D; NEW-ONSET EPILEPSY; DISPARITIES; ADHERENCE; COPAYMENTS; IMPACT; Health Care Sciences & Services; antiepileptic drugs
• Research Categories: Health Sciences, Obstetrics and Gynecology; Health Sciences, Medicine and Surgery

Abstract

Background: Enzyme-inducing antiepileptic drugs (EI-AEDs) are not recommended for older adults with epilepsy. Quality Indicator for Epilepsy Treatment 9 (QUIET-9) states that new patients should not receive EI-AEDs as first line of treatment. In light of reported racial/ethnic disparities in epilepsy care, we investigated EI-AED use and QUIET-9 concordance across major racial/ethnic groups of Medicare beneficiaries. Research Design: Retrospective analyses of 2008-2010 Medicare claims for a 5% random sample of beneficiaries 67 years old and above in 2009 augmented for minority representation. Logistic regressions examined QUIET-9 concordance differences by race/ethnicity adjusting for individual, socioeconomic, and geography factors. Subjects: Epilepsy prevalent (≥1 International Classification of Disease-version 9 code 345.x or ≥2 International Classification of Disease-version 9 code 780.3x, ≥1 AED), and new (same as prevalent+no seizure/epilepsy events nor AEDs in 365 d before index event) cases. Measures: Use of EI-AEDs and QUIET-9 concordance (no EI-AEDs for the first 2 AEDs). Results: Cases were 21% white, 58% African American, 12% Hispanic, 6% Asian, 2% American Indian/Alaskan Native. About 65% of prevalent, 43.6% of new cases, used EI-AEDs. QUIET-9 concordance was found for 71% Asian, 65% white, 61% Hispanic, 57% African American, 55% American Indian/Alaskan new cases: racial/ethnic differences were not significant in adjusted model. Beneficiaries without neurology care, in deductible drug benefit phase, or in high poverty areas were less likely to have QUIET-9 concordant care. Conclusions: EI-AED use is high, and concordance with recommendations low, among all racial/ethnic groups of older adults with epilepsy. Potential socioeconomic disparities and drug coverage plans may affect treatment quality and opportunities to live well with epilepsy.