Abstract Details

Title Trends in Antiseizure Medication Fills and Cost in Medicare Beneficiaries with Epilepsy

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P18 - Poster Session 18 (5:30 PM-6:30 PM)

Poster/Presentation
Number 10-003

Background Tracking real-world prescribing patterns is critical to evaluating uptake of evidence and drug costs.

Objective To characterize trends in antiseizure medication (ASM) fills and costs over time in people with epilepsy.

Design/Methods This was a retrospective cohort study of beneficiaries with epilepsy (ASM, plus International Classification of Diseases codes) in a 20% Medicare sample, with continuous Fee-For-Service coverage (Parts A, B, and D) in 2008-2018. We summed the number of pill days and costs (adjusted to 2018 dollars) per population and year. ASMs were categorized into brand versus generic, older versus newer generation, and inducers versus non-inducers.

Results The most common ASM was phenytoin in 2008, which shifted to levetiracetam (2008: phenytoin 25%, levetiracetam 14%; 2018: phenytoin 9%, levetiracetam 27%). Brand name (2008: 56%; 2018: 13%), older generation (2008: 55%; 2018: 34%), and enzyme-inducing ASMs (2008: 40%; 2018: 23%) decreased over time as a proportion of pill days. The number of brand pill days per person initially decreased (e.g. 2008: 250; 2009: 121; 2010: 96) given a large drop of levetiracetam and valproate brand pill days, but then plateaued (2013-2018: between 64-69) given a notable increase in lacosamide pill days per person (2008: 0; 2018: 20). Total brand name costs per year initially decreased 2008-2010 (2008: $215 million; 2010: $142 million) but then increased after 2010 (2018: $305 million). Cost for a 1-year brand name pill supply per person increased steadily (2008: $3,322; 2018: $10,218).

Conclusions Older generation and enzyme-inducing ASMs waned over time. While brand name ASMs initially waned translating into lower costs and likely higher value care, after 2010 brand name costs markedly increased due to increasing use of lacosamide in addition to escalating per-pill cost of brand name ASMs. Further work is needed to understand drivers of brand name use to inform cost containment efforts.

Authors/Disclosures
Samuel W. Terman, MD (University of Michigan, Neurology Dept) PRESENTER	Dr. Terman has received research support from American Epilepsy Society. Dr. Terman has received research support from Epilepsy Study Consortium. Dr. Terman has received research support from New York University. Dr. Terman has received personal compensation in the range of $100,000-$499,999 for serving as a clinician scientist trainee for Susan S Spencer award with American Academy of Neurology.
Chun Chieh Lin, PhD (University of Michigan)	The institution of Chun Chieh Lin has received research support from AAN.
Brian Callaghan, MD, MS, FAAN (University of Michigan Health System)	Dr. Callaghan has received personal compensation for serving as an employee of University of Michigan. Dr. Callaghan has received personal compensation for serving as an employee of Ann Arbor Veterans Affairs. Dr. Callaghan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Dynamed. Dr. Callaghan has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Academy of Neurology. Dr. Callaghan has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Medico-legal work. Dr. Callaghan has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Vaccine Injury Compensation Program. The institution of Dr. Callaghan has received research support from American Academy of Neurology. The institution of Dr. Callaghan has received research support from JDRF. The institution of Dr. Callaghan has received research support from NIDDK. Dr. Callaghan has received personal compensation in the range of $500-$4,999 for serving as a Grant Reviewer with NIH.
James F. Burke, MD (Ohio State Wexner Medical Center)	Dr. Burke has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association/Circulation: Cardiovascular quality and outcomes.