Objective: The purpose of this study was to characterize healthcare resource utilization (HCRU) pre- and post-clobazam initiation among Medicaid patients with probable Lennox-Gastaut syndrome (LGS).
Background: LGS is a severe form of childhood-onset epilepsy. Clobazam was approved in 2011 as an adjunctive treatment for seizures associated with LGS in patients ≥2 years.
Methods: De-identified data from the MarketScan Multi-State Medicaid database (10/1/2010 through 3/31/2014) were used to identify patients with probable LGS (≥2 claims for generalized convulsive or non-convulsive epilepsy and ≥1 claim for developmental disorder or cognitive impairment) who initiated clobazam following the first claim suggestive of LGS. Seizure-related HCRU in the 12 months pre-clobazam initiation was compared with seizure-related HCRU in the 12 months post-clobazam initiation.
Results: A total of 358 clobazam-treated patients with probable LGS and a minimum of 12-months follow-up post-treatment initiation were identified. Most patients were ≤12 years old (27.9[percnt], 0-5 y; 34.4[percnt], 6-12 y; mean age = 12.6 y) and had a filled prescription for at least 1 anti-epileptic drug (AED) prior to clobazam use [mean number of AEDs: 1.9±1.1 (SD)]. In the 12 months following clobazam initiation, significantly smaller proportions of patients were hospitalized (22.4[percnt] vs 33.0[percnt], P<.001) or visited the emergency room (29.3[percnt] vs 36.3[percnt], P=0.013) due to seizure-related events compared with the 12-month pre-clobazam period. Mean seizure-related inpatient (hospitalization, ER) and outpatient (office, laboratory) visits post-clobazam initiation also were significantly reduced.
Conclusions: Among Medicaid enrollees with probable LGS, clobazam treatment resulted in fewer seizure-related inpatient and outpatient services compared with an analogous period before clobazam initiation.
Funded by Lundbeck, LLC Disclosure: Dr. Stern received personal compensation for activities with UCB Pharma, Sunovian, Lundbeck, Eisai Inc., and Cyberonics as an advisor and/or speaker. Dr. Stern has received personal compensation in an editorial capacity for MedLink Neurology as editor. Dr. Francois holds stock and/or stock options in Lundbeck. Dr. Ogbonnaya has received personal compensation for activities with Xcenda as an employee. Dr. Lokhandwala has received personal compensation for activities with Xcenda as an employee. Ms. Landsman-Blumberg has received compensation for activities with Xcenda as an employee. Dr. Duhig holds stock in Abbott. Dr. Shen has received personal compensation for activities with Lundbeck Inc. as an employee.
To discover the predictors of change in the frequency of heavy drinking (HD) over a 4-year period in alcohol dependent (AD)-individuals identified in the general population, namely, among participants of the US National Epidemiologic Survey on Alcohol and Related Conditions interviewed at Wave 1 (2001-2002) and at Wave 2 (2004-2005).The study cohort included subjects meeting DSM-IV criteria for AD in the past year at Wave 1 (n = 1484), who were present at Wave 2 (n = 1172) and had complete data on factors of interest (n = 1123). Frequency of HD was defined as the number of HD days (HDD) (≥5 drinks per day for men and ≥4 for women). Change in frequency of HDD from baseline (Wave 1) to ~3 years later (Wave 2) was determined. An analysis of covariance model (ANCOVA), adjusting for baseline HDD, was used to examine individual factors associated with change in frequency of HDD, while a multivariable regression model was employed to assess factors associated with change in frequency of HDD simultaneously.Overall, there was a decrease in mean (SE) HDD [from 119.4 (1.8) at Wave 1 to 82.5 (2.1) at Wave 2, P < 0.0001]. Compared with smokers, non-smokers had a mean (SE) HDD reduction of 13.4 (6.7), P < 0.05. AD criteria of tolerance was significantly associated (P < 0.05) with less reduction in HDD. Change in depression/dysthymia status was associated with greater reduction in HDD in the ANCOVA model, but not the fully adjusted multivariable model.Findings from this study suggest that smoking and AD criteria of tolerance are important factors for long-term follow-up of AD patients and they should influence the selection of the kinds of interventions required for AD patients to achieve maximal therapeutic benefit.
Objective, complete estimates of nursing home (NH) use across the spectrum of cognitive decline are needed to help predict future care needs and inform economic models constructed to assess interventions to reduce care needs.Retrospective longitudinal study.Olmsted County, MN.Mayo Clinic Study of Aging participants assessed as cognitively normal (CN), mild cognitive impairment (MCI), previously unrecognized dementia, or prevalent dementia (age = 70-89 years; N = 3,545).Participants were followed in Centers for Medicare and Medicaid Services (CMS) Minimum Data Set (MDS) NH records and in Rochester Epidemiology Project provider-linked medical records for 1-year after assessment of cognition for days of observation, NH use (yes/no), NH days, NH days/days of observation, and mortality.In the year after cognition was assessed, for persons categorized as CN, MCI, previously unrecognized dementia, and prevalent dementia respectively, the percentages who died were 1.0%, 2.6%, 4.2%, 21%; the percentages with any NH use were 3.8%, 8.7%, 19%, 40%; for persons with any NH use, median NH days were 27, 38, 120, 305, and median percentages of NH days/days of observation were 7.8%, 12%, 33%, 100%. The year after assessment, among persons with prevalent dementia and any NH use, >50% were a NH resident all days of observation. Pairwise comparisons revealed that each increase in cognitive impairment category exhibited significantly higher proportions with any NH use. One-year mortality was especially high for persons with prevalent dementia and any NH use (30% vs 13% for those with no NH use); 58% of all deaths among persons with prevalent dementia occurred while a NH resident.Findings suggest reductions in NH use could result from quality alternatives to NH admission, both among persons with MCI and persons with dementia, together with suitable options for end-of-life care among persons with prevalent dementia.
The presentation of Alzheimer's disease (AD) differs little between countries, but the treatment of AD may differ by geography. One area of interest is augmentation of cholinesterase inhibitors with memantine. However, there are few published data on how this may vary between countries, over time, and clinical factors associated with the decision to augment. We analysed data from the Adelphi Dementia Disease Specific Programme, a cross-sectional study of AD in France, Germany, Italy, Spain, UK, and US. Physicians reported on: demographics of their patients; severity of behavioural and psychological symptoms (taken together) and functional symptoms. Cognition was measured using the MMSE. Associations between augmentation during the year prior to data collection, MMSE, and symptom severity in functional, behavioural and psychological domains, were analysed using ordinary least squares regression controlling for age and country. Data were collected in 2006, 2008 and 2010. Observed rates of augmentation in 2010 varied by country, with the highest level being reported in the US 16% (133/529). The US augmentation rate was statistically significantly higher (χ2 tests P<0.0001 for all comparisons) than in Spain 8% (40/512), France 7% (44/585), Germany 3% (11/380), Italy 2% (8/354) and the UK 1% (5/529). On multivariate analysis controlling for age, the differences between the US and Europe remained (P<0.001 for all contrasts). Over time, the rate of augmentation in the US declined (2006=24%; 2008=19%; 2010=16%) while in Europe it generally increased: France (1%; 0%; 7%); Germany (0%; 1%; 3%); Italy (0%; 0%; 2%); Spain (1%; 3%; 8%); UK (0%; 1%; 1%). On multivariate analysis, augmentation was not associated with cognition (MMSE) or age. However, there were statistically significant associations with having any functional impairment as compared to none (OR = 2.30; 95%CI 1.21-4.40; P = 0.012) and behavioural and psychological symptoms of moderate or greater severity (OR = 2.12; 95%CI 1.47-3.07; P<0.001). There appears to be cross-national variation in the augmentation of cholinesterase inhibitors with memantine. The rates in the US are higher than those in Europe. Augmentation appears related to the impact of functional and behavioural and psychological symptoms as well as country.
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