OBJECTIVES:

To assess the difference in health care resource utilization (HCRU) and medical costs before and after initiation of Epidiolex, among commercially insured patients with Dravet syndrome (DS), Lennox-Gastaut syndrome (LGS), tuberous sclerosis complex (TSC), and other refractory epilepsies.

METHODS:

This is a retrospective pre-post study using the US MarketScan^® administrative claims database. Patients were included if they had LGS, DS, TSC, or other refractory epilepsies and initiated Epidiolex between June 2019 to June 2021, with 180 days of continuous enrollment in commercial health plans before and after the initiation. HCRU and medical costs include physician office, hospital outpatient, emergency department (ER), home health, inpatient admission, and ICU admission. The within-person differences between outcomes in the 6-month baseline and follow-up were analyzed. Time series plots were used to explore trends in HCRU and the impact of COVID-19.

RESULTS:

A total of 506 patients were included with a mean age of 16±11 and 49% female. LGS accounted for 271 patients, 15 each for DS and TSC, and 205 for other refractory epilepsies. Intellectual disorder was the most frequent comorbidity (51%), followed by autism (19%). About 44% of patients had Charlson Comorbidity Index greater than 3. The mean difference in the number of visits per patient is -0.07 (p=0.009) for ER and -0.14 (p=0.042) for the physician office with epilepsy as 1^st or 2^nd diagnosis. The physician office and ER visits cost were 14% and 46% lower (p=0.002). No notable differences were observed in the other outcomes. Time series plots show a progressively increasing HCRU before Epidiolex initiation and progressively decreasing HCRU after, and COVID-19 effects on HCRU were limited to the lockdown period.

CONCLUSIONS:

After the initiation of Epidiolex, the average physician office and ER visits and costs were lower in the study period among commercially insured patients in the US