A Life-Course Assessment of Treatment Patterns and Healthcare Costs of Lennox-Gastaut Syndrome (LGS) (P1.085)
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".