Healthcare Utilization and Cost in the Two Years Before Neuromodulation Implantation Among Medicaid Enrollees with Drug-Resistant Epilepsy
Bibliographic record
Abstract
Kathryn Evans,1 Qian Li,1 Lu Zhang,2 Sandi Lam,2 Bronwyn Do Rego,3 Vanessa Danielson,3 Reginald Lassagne,3 Ariel Berger1 1Thermo Fisher Scientific, Waltham, MA, USA; 2Department of Neurosurgery, Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; 3LivaNova, London, UKCorrespondence: Ariel Berger, Email ariel.berger@thermofisher.comBackground: Current treatment guidelines recommend consideration of neurostimulators and other alternative treatments to antiseizure medications in patients with drug-resistant epilepsy (DRE). This study assessed patterns of utilization and cost of healthcare services and prescription pharmacotherapies during the 2-year period before neurostimulator implantation among Medicaid enrollees with DRE.Methods: This retrospective, observational cohort study used healthcare claims and enrollment data obtained from the US Centers for Medicare and Medicaid Services. Medicaid enrollees who met study selection criteria (ie, evidence of DRE and neurostimulator implantation) between January 1, 2011, and December 31, 2020, were included. Those without antiseizure medication (ASM) dispenses within 12 months of their implantation date or continuous enrollment for the 24-month period before this date were excluded. Demographic/clinical characteristics, utilization and cost of healthcare services, and prescription pharmacotherapies were assessed over the 2-year period before implantation. Care was designated as all-cause or epilepsy-related; the latter was defined as all ASM dispenses and all claims for medical care (ie, inpatient or outpatient) with a diagnosis code (any position) of epilepsy.Results: In total, 2469 patients met the selection criteria. Mean age at implantation was 20.8 years. Comorbidities were common. Over the 2-year period before implantation, patients were prescribed a mean of 4.4 unique ASMs. Fifty-seven percent had at least one all-cause hospital admission, and 82.9% had at least one all-cause emergency department visit; corresponding epilepsy-related values were 55.3% and 66.1%. Less than half of patients received specific cranial imaging, including video electroencephalographs. Total mean all-cause healthcare costs were $117,013; epilepsy-related healthcare costs accounted for $48,169 (41.2%).Conclusion: Medicaid enrollees with DRE experience high use and cost of healthcare services and pharmacotherapy over the 2 years before neurostimulator implantation. Further research is needed to understand the impacts associated with broader access to specialized epilepsy care, such as cranial imaging and neurostimulators.Keywords: drug-resistant epilepsy, neuromodulation, medicaid, antiseizure medications, neurostimulator implantation, healthcare costs
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| 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".