Use of a new antiepileptic drug in an HMO: Economic outcomes from the payer perspective

Despite optimism about the potential therapeutic benefit of new antiepileptic agents, little is known about how these drugs affect the total cost of patient care. The objective of this study was to assess and describe the economic impact of felbamate from the perspective of a payer in a managed care setting. A relational database was retrospectively analyzed for the period of January 1, 1993, through March 31, 1995, for medical and prescription claims associated with the treatment of epilepsy. Costs were assigned to the following categories: prescription, outpatient laboratory, outpatient medical services, hospital (including inpatient and emergency department episodes), and other. More than 2,000 healthcare claims associated with epilepsy treatment were identified for the 52 subjects, 26 of whom received felbamate, and 26 of whom did not. A repeated-measures design was used to assess healthcare expenditures for the felbamate-treated patients, and independent group analysis compared these study subjects with members of the comparison group. Analysis was conducted between mean 6-month periods prefelbamate, "on" felbamate, and postfelbamate. Mean total healthcare costs per subject per month were significantly higher during felbamate therapy than during either the prefelbamate or postfelbamate period ($333, compared with $151 and $122, respectively). Mean hospital-associated costs were greatly elevated while patients received felbamate ($175, compared with $25 prefelbamate and $23 postfelbamate). Relative to the comparison group, patients who received felbamate generated higher mean prescription and medical service costs while receiving felbamate and generated consistently higher medical and prescription costs. Claims data can provide useful insights into economic outcomes and resource utilization associated with changes in pharmacologic therapy, and its use allows for the identification of specific pharmacologic agents in need of clinical outcomes assessment.