Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study
Abstract Background For the two-thirds of patients with epilepsy who achieve seizure remission on antiseizure medications (ASMs), patients and clinicians must weigh the pros and cons of long-term ASM treatment. However, little work has evaluated how often ASM discontinuation occurs in practice. We d...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-09-01
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| Series: | BMC Neurology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12883-022-02852-6 |
| _version_ | 1798004412438806528 |
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| author | Samuel W. Terman Joshua D. Niznik Geertruida Slinger Willem M. Otte Kees P. J. Braun Carole E. Aubert Wesley T. Kerr Cynthia M. Boyd James F. Burke |
| author_facet | Samuel W. Terman Joshua D. Niznik Geertruida Slinger Willem M. Otte Kees P. J. Braun Carole E. Aubert Wesley T. Kerr Cynthia M. Boyd James F. Burke |
| author_sort | Samuel W. Terman |
| collection | DOAJ |
| description | Abstract Background For the two-thirds of patients with epilepsy who achieve seizure remission on antiseizure medications (ASMs), patients and clinicians must weigh the pros and cons of long-term ASM treatment. However, little work has evaluated how often ASM discontinuation occurs in practice. We describe the incidence of and predictors for sustained ASM fill gaps to measure discontinuation in individuals potentially eligible for ASM withdrawal. Methods This was a retrospective cohort of Medicare beneficiaries. We included patients with epilepsy by requiring International Classification of Diseases codes for epilepsy/convulsions plus at least one ASM prescription each year 2014–2016, and no acute visit for epilepsy 2014–2015 (i.e., potentially eligible for ASM discontinuation). The main outcome was the first day of a gap in ASM supply (30, 90, 180, or 360 days with no pills) in 2016–2018. We displayed cumulative incidence functions and identified predictors using Cox regressions. Results Among 21,819 beneficiaries, 5191 (24%) had a 30-day gap, 1753 (8%) had a 90-day gap, 803 (4%) had a 180-day gap, and 381 (2%) had a 360-day gap. Predictors increasing the chance of a 180-day gap included number of unique medications in 2015 (hazard ratio [HR] 1.03 per medication, 95% confidence interval [CI] 1.01–1.05) and epileptologist prescribing physician (≥25% of that physician’s visits for epilepsy; HR 2.37, 95% CI 1.39–4.03). Predictors decreasing the chance of a 180-day gap included Medicaid dual eligibility (HR 0.75, 95% CI 0.60–0.95), number of unique ASMs in 2015 (e.g., 2 versus 1: HR 0.37, 95% CI 0.30–0.45), and greater baseline adherence (> 80% versus ≤80% of days in 2015 with ASM pill supply: HR 0.38, 95% CI 0.32–0.44). Conclusions Sustained ASM gaps were rarer than current guidelines may suggest. Future work should further explore barriers and enablers of ASM discontinuation to understand the optimal discontinuation rate. |
| first_indexed | 2024-04-11T12:23:17Z |
| format | Article |
| id | doaj.art-121c1d359fdf418788ccc48abbee6f67 |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-04-11T12:23:17Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-121c1d359fdf418788ccc48abbee6f672022-12-22T04:24:01ZengBMCBMC Neurology1471-23772022-09-0122111410.1186/s12883-022-02852-6Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort studySamuel W. Terman0Joshua D. Niznik1Geertruida Slinger2Willem M. Otte3Kees P. J. Braun4Carole E. Aubert5Wesley T. Kerr6Cynthia M. Boyd7James F. Burke8Department of Neurology, University of MichiganDivision of Geriatric Medicine, Center for Aging and Health, School of Medicine, University of North Carolina At Chapel HillDepartment of Child Neurology, University Medical Center Utrecht, Utrecht UniversityDepartment of Child Neurology, University Medical Center Utrecht, Utrecht UniversityDepartment of Child Neurology, University Medical Center Utrecht, Utrecht UniversityDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of BernDepartment of Neurology, University of MichiganDivision of Geriatric Medicine and Gerontology, Johns Hopkins University School of MedicineDepartment of Neurology, the Ohio State UniversityAbstract Background For the two-thirds of patients with epilepsy who achieve seizure remission on antiseizure medications (ASMs), patients and clinicians must weigh the pros and cons of long-term ASM treatment. However, little work has evaluated how often ASM discontinuation occurs in practice. We describe the incidence of and predictors for sustained ASM fill gaps to measure discontinuation in individuals potentially eligible for ASM withdrawal. Methods This was a retrospective cohort of Medicare beneficiaries. We included patients with epilepsy by requiring International Classification of Diseases codes for epilepsy/convulsions plus at least one ASM prescription each year 2014–2016, and no acute visit for epilepsy 2014–2015 (i.e., potentially eligible for ASM discontinuation). The main outcome was the first day of a gap in ASM supply (30, 90, 180, or 360 days with no pills) in 2016–2018. We displayed cumulative incidence functions and identified predictors using Cox regressions. Results Among 21,819 beneficiaries, 5191 (24%) had a 30-day gap, 1753 (8%) had a 90-day gap, 803 (4%) had a 180-day gap, and 381 (2%) had a 360-day gap. Predictors increasing the chance of a 180-day gap included number of unique medications in 2015 (hazard ratio [HR] 1.03 per medication, 95% confidence interval [CI] 1.01–1.05) and epileptologist prescribing physician (≥25% of that physician’s visits for epilepsy; HR 2.37, 95% CI 1.39–4.03). Predictors decreasing the chance of a 180-day gap included Medicaid dual eligibility (HR 0.75, 95% CI 0.60–0.95), number of unique ASMs in 2015 (e.g., 2 versus 1: HR 0.37, 95% CI 0.30–0.45), and greater baseline adherence (> 80% versus ≤80% of days in 2015 with ASM pill supply: HR 0.38, 95% CI 0.32–0.44). Conclusions Sustained ASM gaps were rarer than current guidelines may suggest. Future work should further explore barriers and enablers of ASM discontinuation to understand the optimal discontinuation rate.https://doi.org/10.1186/s12883-022-02852-6EpilepsyAntiseizure medicationsAdministrative claimsDiscontinuation |
| spellingShingle | Samuel W. Terman Joshua D. Niznik Geertruida Slinger Willem M. Otte Kees P. J. Braun Carole E. Aubert Wesley T. Kerr Cynthia M. Boyd James F. Burke Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study BMC Neurology Epilepsy Antiseizure medications Administrative claims Discontinuation |
| title | Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study |
| title_full | Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study |
| title_fullStr | Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study |
| title_full_unstemmed | Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study |
| title_short | Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study |
| title_sort | incidence of and predictors for antiseizure medication gaps in medicare beneficiaries with epilepsy a retrospective cohort study |
| topic | Epilepsy Antiseizure medications Administrative claims Discontinuation |
| url | https://doi.org/10.1186/s12883-022-02852-6 |
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