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

• 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
• Journal Title: Medical Care
• Volume: Volume 55, Number 7
• Publisher: Lippincott, Williams & Wilkins | 2017-07-01, Pages 677-683
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/MLR.0000000000000724
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Obstetrics and Gynecology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health; epilepsy; antiepileptic drugs; enzyme-inducing drugs; Medicare; administrative claims; Medicare part D; NEW-ONSET EPILEPSY; CLINICAL COMORBIDITY INDEX; HEALTH-CARE UTILIZATION; PART D; INTERNATIONAL LEAGUE; DRUG; DISPARITIES; ADHERENCE; IMPACT; COPAYMENTS

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.