June 7, 2019

High Health Care Costs in Minority Groups of Older US Medicare Beneficiaries with Epilepsy

Objective: To examine health care costs in diverse older Medicare beneficiaries with epilepsy.

Methods: Using 2008-2010 claims data, researchers conducted a longitudinal cohort study of a random sample of Medicare beneficiaries augmented for minority representation. Epilepsy cases (n = 36,912) had at least 1 International Classification of Diseases, Ninth Edition (ICD-9) 345.x or at least 2 ICD-9 780.3x claims, and at least 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 at least 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, the researchers 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% African Americans cases had high cost. African Americans 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 at least 1 comorbidity, neurological care, and low antiepileptic drug 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 consequences of epilepsy among older Americans disproportionally affect minorities. Studies should examine contributors to high cost.

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