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Author Notes:

Corresponding Author: Maria Pisu, PhD, University of Alabama at Birmingham, Division of Preventive Medicine, 1717 11th Ave South, MT 636, Birmingham, AL 35294-4410, Phone: 205-975-7366; Fax: 205-934-7959, mpisu@uab.edu

Dr. Faught has received research support from Brain Sentinel, Eisai, and UCB Pharma, has served on Data Monitoring Boards for Eisai, Lundbeck, SAGE, and SK Life Science, and has received consultation fees from Aprecia, Supernus, Sunovion, and UCB Pharma

Drs. Pisu, Richman, Piper, Martin, Funkhouser, Mr. Dai, and Ms. Juarez, report nothing to disclose.

Authors are grateful to Aquila Brown-Galvan, Nancy Cohen, Kay Clements for administrative support, medical coding, and clinical input.

The funder had no role in the design and conduct of the study, collection, management, analysis, and interpretation of data, and preparation, review or approval of this manuscript.

Subjects:

Research Funding:

The authors are grateful for support from the National Institute of Neurological Disorders and Stroke (1R01NS080898-01).

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

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

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

Tools:

Journal Title:

Medical Care

Volume:

Volume 55, Number 7

Publisher:

, Pages 677-683

Type of Work:

Article | Post-print: After Peer Review

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.

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© 2017 Wolters Kluwer Health, Inc. All rights reserved.

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