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  • Seizure frequency, healthcare resource utilisation and mortality in childhood epilepsy: a retrospective cohort study using the THIN database

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Original article
Seizure frequency, healthcare resource utilisation and mortality in childhood epilepsy: a retrospective cohort study using the THIN database
  1. Melissa Myland1,
  2. Brian Buysse1,
  3. Wan Tsong2,
  4. G Sarah Power1,
  5. Douglas Nordli3,
  6. Richard F M Chin4,5
  1. 1 IQVIA, London, UK
  2. 2 Eisai Inc, Woodcliff Lake, UK
  3. 3 Children’s Hospital of Los Angeles, Los Angeles, USA
  4. 4 Muir Maxwell Epilepsy Centre, Edinburgh, UK
  5. 5 Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
  1. Correspondence to Dr Richard F M Chin, Muir Maxwell Epilepsy Centre, Edinburgh EH8 9XD, UK; r.chin{at}ed.ac.uk

Abstract

Objective To understand the association of seizure frequency with healthcare resource utilisation (HCRU) and mortality in UK children with epilepsy (CWE).

Design Retrospective cohort study.

Setting Routinely collected data in primary care from The Health Improvement Network UK database.

Patients CWE ≥1 and<18 years of age with a record of seizure frequency were included in mortality analyses from 2005 to 2015 and HCRU analyses from 2010 to 2015.

Main outcome measures Frequency of HCRU contacts during the year following latest seizure frequency and mortality (descriptive and Cox proportional hazards regression) from first record of seizure frequency.

Results Higher seizure frequency was related to increased HCRU utilisation and mortality. In negative binomial regression, each category increase in seizure frequency related to 11% more visits to general practitioners, 35% more inpatient admissions, 15% more outpatient visits and increased direct HCRU costs (24%). 11 patients died during 12 490 patient-years follow-up. The unadjusted HR of mortality per higher category of seizure frequency was 2.56 (95% CI: 1.52 to 4.31). Adjustment for age and number of prescribed anti-epileptic drugs at index attenuated this estimate to 2.11 (95% CI: 1.24 to 3.60).

Conclusion Higher seizure frequency is associated with greater HCRU and mortality in CWE in the UK. Improvement in seizure control may potentially lead to better patient outcomes and reduced healthcare use.

  • epidemiology
  • neurology
  • paediatric practice

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/archdischild-2019-316910

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    Footnotes

    • Contributors MM and BB designed the study. SP conducted the analysis. MM, WT, DN and RC interpreted the data. MM drafted the manuscript. All authors reviewed and approved the final version of the manuscript.

    • Funding This work was supported by Eisai Inc.

    • Competing interests The authors declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article. RC has received honoraria and study participation fees from Eisai Inc. BB, MM and SP were employees of IQVIA at the time of study conduct. IQVIA received funding from Eisai Inc to conduct the study. WT was an employee of Eisai Inc at the time of study conduct. The lead author affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

    • Ethics approval This study received approval from the THIN Scientific Review Committee on 8th August 2016 (reference: 16THIN065).

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Data sharing statement Additional study data may contain patient identifiable information; requests for such data will be reviewed by IQVIA to protect patient confidentiality.

    • Patient consent for publication Not required.