Clinical and Economic Burden of Uncontrolled Epilepsy: Analyses From a Medicaid Database and a Private Health Plan Database
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| ClinicalTrials.gov Identifier: NCT01390909 |
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Recruitment Status :
Completed
First Posted : July 11, 2011
Results First Posted : February 14, 2012
Last Update Posted : October 8, 2012
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Sponsor:
GlaxoSmithKline
Information provided by (Responsible Party):
GlaxoSmithKline
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Brief Summary:
Antiepileptic drugs (AEDs) are the main therapeutic option for patients with epilepsy; however, complete seizure control remains elusive for many patients. Uncontrolled or refractory epilepsy is associated with a higher risk of mortality, physical injuries, and depression or anxiety compared with patients with controlled epilepsy. Higher resource utilization for patients with poor control is likely to be associated with higher economic costs. While diagnostic criteria for uncontrolled epilepsy are debated by neurologists, recent studies suggest that a diagnosis of uncontrolled epilepsy requires 1.) at least one seizure per month and 2.) a history of drug failures.
The objective of this study is to identify patients with uncontrolled epilepsy in both a Medicaid database and a private health plan database, to describe patient characteristics and AED treatment patterns between cohorts of patients with uncontrolled versus well-controlled epilepsy, and to evaluate the economic burden of uncontrolled versus well-controlled epilepsy.
For this evaluation, the data sources are medical and pharmacy claims in Medicaid databases from Florida (Third quarter 1997 to second quarter 2008), Iowa (First quarter 1998 to second quarter 2006), Kansas (First quarter 2001 to second quarter 2009), Missouri (First quarter 1997 to second quarter 2008) and New Jersey (First quarter 1997 to fourth quarter 2008) and medical and pharmacy claims in an private health plan database.
The study design is a retrospective, longitudinal, matched-cohort study. Eligible patient records will be assigned to one of three mutually-exclusive cohorts: uncontrolled epilepsy (at least 2 consecutive changes in AED therapy in at least 30 days, and at least 1 epilepsy-related inpatient or emergency department (ED) visit within 365 days), well-controlled epilepsy (no AED changes and no epilepsy-related inpatient or ED visits), and intermediate epilepsy (not classified as uncontrolled or well-controlled).
| Condition or disease | Intervention/treatment |
|---|---|
| Epilepsy | Drug: Anti-epileptic drug (AED) |
| Study Type : | Observational |
| Actual Enrollment : | 12386 participants |
| Observational Model: | Cohort |
| Time Perspective: | Retrospective |
| Official Title: | Clinical and Economic Burden of Uncontrolled Epilepsy: Analyses From a Medicaid Database and a Private Health Plan Database |
| Study Start Date : | May 2010 |
| Actual Primary Completion Date : | January 2011 |
| Actual Study Completion Date : | January 2011 |
Resource links provided by the National Library of Medicine
MedlinePlus Genetics related topics:
Pyridoxal 5'-phosphate-dependent epilepsy
MedlinePlus related topics:
Epilepsy
| Group/Cohort | Intervention/treatment |
|---|---|
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Medicaid patients with uncontrolled epilepsy
Database records for patients with 2 or more consecutive changes in anti-epileptic drug (AED) therapy occurring at least 30 days apart and followed by 1 or more epilepsy-related inpatient or emergency department (ED) visits within the 365 days
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Drug: Anti-epileptic drug (AED)
Prescription claim for at least one AED including lamotrigine, tiagabine, pregabalin, ethosuximide, lacosamide, phenytoin, carbamazepine, valproic acid, felbamate, levetiracetam, zonisamide, primidone, oxcarbazepine, vigabatrin, phenobarbital, gabapentin, topiramate.
Other Names:
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Medicaid patients with well-controlled epilepsy
Database records for patients with an epilepsy diagnosis but no AED change and no epilepsy-related inpatient or ED visits
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Drug: Anti-epileptic drug (AED)
Prescription claim for at least one AED including lamotrigine, tiagabine, pregabalin, ethosuximide, lacosamide, phenytoin, carbamazepine, valproic acid, felbamate, levetiracetam, zonisamide, primidone, oxcarbazepine, vigabatrin, phenobarbital, gabapentin, topiramate.
Other Names:
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Medicaid patients with intermediate epilepsy
Database records for patients who are not classified as uncontrolled or well-controlled
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Drug: Anti-epileptic drug (AED)
Prescription claim for at least one AED including lamotrigine, tiagabine, pregabalin, ethosuximide, lacosamide, phenytoin, carbamazepine, valproic acid, felbamate, levetiracetam, zonisamide, primidone, oxcarbazepine, vigabatrin, phenobarbital, gabapentin, topiramate.
Other Names:
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Patients in a private health plan with uncontrolled epilepsy
Database records for patients with 2 or more consecutive changes in AED therapy occuring at least 30 days apart and followed by 1 or more epilepsy-related inpatient or ED visits within 365 days
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Drug: Anti-epileptic drug (AED)
Prescription claim for at least one AED including lamotrigine, tiagabine, pregabalin, ethosuximide, lacosamide, phenytoin, carbamazepine, valproic acid, felbamate, levetiracetam, zonisamide, primidone, oxcarbazepine, vigabatrin, phenobarbital, gabapentin, topiramate.
Other Names:
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Patients in a private health plan with well-controlled epileps
Database records for patients with an epilepsy diagnosis but no AED change and no epilepsy-related inpatient or ED visits
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Drug: Anti-epileptic drug (AED)
Prescription claim for at least one AED including lamotrigine, tiagabine, pregabalin, ethosuximide, lacosamide, phenytoin, carbamazepine, valproic acid, felbamate, levetiracetam, zonisamide, primidone, oxcarbazepine, vigabatrin, phenobarbital, gabapentin, topiramate.
Other Names:
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Patients in a private health plan with intermediate epilepsy
Database records for patients who are not classified as uncontrolled or well-controlled
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Drug: Anti-epileptic drug (AED)
Prescription claim for at least one AED including lamotrigine, tiagabine, pregabalin, ethosuximide, lacosamide, phenytoin, carbamazepine, valproic acid, felbamate, levetiracetam, zonisamide, primidone, oxcarbazepine, vigabatrin, phenobarbital, gabapentin, topiramate.
Other Names:
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Primary Outcome Measures :
- Average Annualized Costs [ Time Frame: 1 year ]Average annualized overall healthcare costs and epilepsy-related healthcare costs were calculated for each treatment group. Epilepsy-related costs were those with a code for epilepsy. ED, Emergency Department; AMC, All Medical Costs; Ep Rel, Epilepsy Related. United States dollars were consumer price index adjusted for 2009.
Information from the National Library of Medicine
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| Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
| Sampling Method: | Non-Probability Sample |
Study Population
The electronic records from adult patients with epilepsy who are enrolled in Medicaid in Florida, Iowa, Kansas, Missouri or New Jersey or in a private health plan database. Patient records will be classified into one of three mutually-exclusive cohorts: uncontrolled epilepsy, well-controlled epilepsy, and intermediate epilepsy (not classified as uncontrolled or well-controlled).
Criteria
Inclusion Criteria:
- At least 18 years of age at the initiation of anti-epileptic drug (AED) treatment as noted in the database
- A record of at least one medical visit with a diagnosis of epilepsy (ICD-9-CM 345.xx) or at least two diagnoses of non-febrile convulsions (ICD-9-CM 780.30 or 780.39) occuring more than 30 days apart
- At least one pharmacy claim for an anti-epileptic drug (AED)
- Continuous enrollment throughout the observation period (minimum of 365 days). Patients with gaps in Medicaid enrollment will be observed only during their period of continuous enrollment, provided that all the above criteria are met
Exclusion Criteria:
- Age less than 18 years
Information from the National Library of Medicine
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01390909
Sponsors and Collaborators
GlaxoSmithKline
Investigators
| Study Director: | GSK Clinical Trials | GlaxoSmithKline |
| Responsible Party: | GlaxoSmithKline |
| ClinicalTrials.gov Identifier: | NCT01390909 |
| Other Study ID Numbers: |
113917 |
| First Posted: | July 11, 2011 Key Record Dates |
| Results First Posted: | February 14, 2012 |
| Last Update Posted: | October 8, 2012 |
| Last Verified: | June 2012 |
Keywords provided by GlaxoSmithKline:
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epilepsy anti-epileptic drug polytherapy adherence Medicaid |
Additional relevant MeSH terms:
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Epilepsy Brain Diseases Central Nervous System Diseases Nervous System Diseases Oxcarbazepine Anticonvulsants Lactitol Cathartics |
Gastrointestinal Agents Molecular Mechanisms of Pharmacological Action Membrane Transport Modulators Sodium Channel Blockers Cytochrome P-450 CYP3A Inducers Cytochrome P-450 Enzyme Inducers Voltage-Gated Sodium Channel Blockers |