Abstracts

The introduction of new antiepileptic drugs (AEDs) and other new techniques for the diagnosis and treatment of epileptic seizures had increased the cost of epilepsy. This study aim to determine the relationship between seizure severity/frequency, socio-economic factors and coverage of medical expenses with the monthly cost of AEDs.
288 patient with epilepsy admitted for VEEG monitoring at the Cleveland Clinic Foundation (CCF) were studied. Patients completed a questionnaire regarding demographics, seizure variables, socio-economic variables, health care utilization, coverage for medical expenses, and self-rating quality of life (QOL) that was created at the CCF. The monthly cost of AEDs was compared (Pearson x²) or correlated (Pearson[rsquo]s R coefficient) with the following variables: seizure severity/frequency, seizure and epilepsy classification, health care utilization, major daily activities, coverage for medical expenses, discontinuation of AEDs due to cost and self-reported QOL. Differences were established when more than 95% of significance was obtained.
No correlation between seizure variables and monthly cost of AEDs was found. Patients who had a higher monthly cost of AEDs were more likely to be on polytherapy (x²=85.68, p=0.000) (Pearson[rsquo]s R = 0.213; p=0.000), including 3 or more drugs (x²=99.65, p=0.000) (Pearson[rsquo]s R = 0.191; p=0.001) and have more adverse effects due to AEDs (Pearson[rsquo]s R = 0.220; p=0.000). Patients with higher monthly cost of AEDs were also more likely to have income from the government (SSI or SSD)(x² = 15.34, p=0.009) (Pearson[rsquo]s R = 0.236; p=0.000) and assistance from federal government programs to pay for medications (x² =28.13, p=0.000) (Pearson[rsquo]s R = 0.274; p=0.000). This group also have the poorest self-reported QOL (Pearson[rsquo]s R = -0.144; p=0.023). Current disability and (x² =10.43, p=0.064) and discontinuation of AEDs due to cost (x² =10.25, p=0.069) correlated weakly with monthly cost of AEDs. A positive correlation between higher monthly cost of AEDs and disability (Pearson[rsquo]s R = 0.163; p=0.008) and higher monthly cost of AEDs and discontinuation of AEDs due to cost (Pearson[rsquo]s R = 0.152; p=0.016) was found.
In this sample of patients with medically refractory epilepsy, cost of AEDs was not related to seizure severity/frequency. Rather, monthly AED expenses were related to polytherapy, ability to pay for medications and QOL. Federal government program cover medication expenses in patients with higher monthly AED cost.