A Life-Course Assessment of Treatment Patterns and Healthcare Costs of Lennox-Gastaut Syndrome (LGS) (P1.085)

Objective: To quantify clinical and economic burdens over the natural course of LGS. Background: LGS is a severe pediatric epilepsy disorder with low prevalence that persists into adulthood. Using a recently developed LGS claims-based classifier, LGS treatments, outcomes, and costs were examined. Methods: Health insurance claims for epilepsy patients (≥2 claims for ICD-9 345.xx) of all ages were obtained from 6 state Medicaid programs. LGS patients were identified using a claims-based classifier with random forest methodology and categorized into age cohorts based on observation periods. Patients were assessed for etiologies, syndromal conditions, medication use, and mean healthcare costs by service type. Results were plotted against time-series panels. Results: The proportion of epilepsy patients with LGS increased prior to age 10, then declined gradually (range: 1.0[percnt]-8.4[percnt]). Most common etiologies were brain malformations, encephalopathy, and West syndrome, all peaking in childhood and declining in adulthood. The rate of delayed development reached 79.6[percnt] before age 5 and declined after age 20; the rate of mental retardation reached 44.5[percnt] then stabilized. The majority of LGS patients received ≥1 antiepileptic drug (AED) (range: 62.6[percnt]-82.3[percnt]), although the use of LGS-specific AEDs (clobazam and rufinamide) was uncommon; their greatest use peaked at ages 0-5 years (maximum rate: 17.5[percnt] [clobazam], 7.4[percnt] [rufinamide]), and declined to ~5.5[percnt] at 18, and <1.0[percnt] at 60. Mean total healthcare costs for LGS patients were $32,460-$49,078 per patient per year [PPPY]); costs were $9,273-$28,798 PPPY for all epilepsy patients. For LGS patients, medical costs were the main contributors ($28,830-$44,435 PPPY); pharmacy costs were proportionally small ($1,704-$5,672 PPPY). Conclusions: LGS has a lifelong impact on patients, amassing greater total healthcare and medical costs from childhood through adulthood than all epilepsy patients. LGS-specific AEDs are underutilized in LGS patients. Increased clinical attention to LGS beyond pediatric years is warranted. Funding: Lundbeck, LLC Disclosure: Dr. Montouris has received personal compensation for activities with Lundbeck Research USA, Inc. Acorda Therapeutics, Eisai Inc. for serving on the advisory board member. Dr. Pina-Garza has received personal compensation for activities with Eisai Inc. as a consultant. Dr. Vekeman has nothing to disclose. Dr. Cheng has received personal compensation for activities with the Analysis Group as an employee. Dr. Tuttle has received personal compensation for activities with Analysis Group as an employee. Dr. Giguere-Duval has received personal compensation for activities with Group d9analyse, Ltee as an employee. Dr. Duh has received research support from Cyberonics, Inc and GlaxoSmithKline. Dr. Shen has received personal compensation for activities with Lundbeck Inc. as an employee. Dr. Isojarvi has received personal compensation fro activities with Lundbeck LLC.