Background: Among patients with epilepsy, ~25% also suffer from a type of anxiety disorder, and the presence of anxiety may complicate epilepsy care. Anxiety may impact quality of life and outcomes in epilepsy since some anti-seizure medications (ASMs) can lead to the exacerbation of anxiety symptoms. Furthermore, patients with anxiety are times more likely to suffer from recurrent and uncontrolled seizures. In addition, there is lack of direction and coordination among epileptologists and neurologists on how to manage these comorbidities.

Objective: To demonstrate the excess economic burden due to anxiety among patients with newly treated epilepsy

Methods: Adult patients with newly-treated epilepsy were selected from STATinMED RWD Insights, an all-payer claims database which provides information on approximately 80% of US health care systems. ASM initiation date was designated as the index event and patients were required to be enrolled within a Medicaid plan as of index date, and continuously captured for 12 months pre- and post-index, i.e., baseline and follow-up periods. Furthermore, patients were segmented into cohorts based on the presence or absence of anxiety at baseline. Demographic and clinical characteristics were reported as of the index date and baseline period respectively, and all cause healthcare resource utilization and costs were reported during the follow-up period.

Results: Among the 24,722 patients who were eligible for the study (mean age: 43 years), 8,522 (34.5%) had anxiety at baseline. Patients with anxiety also had a significantly higher mean CCI score (2.0 vs 1.7, p<0.05) and higher rates of gastroesophageal reflux disease (24.3% vs 11.1%), anemia (23.4% vs 16.1%), and depression (51.8% vs 16.7%, all p<0.05). During the follow up period, patients with anxiety had higher usage rates in the inpatient (51.9% vs 43.5%), ER (72.2% vs 61.4%), and outpatient (not including ER or long-term care) setting (47.5% vs 39.9%, all p<0.05). Average number of visits were also higher among patients with anxiety for these settings. In addition, total costs were significantly higher ($50,226 vs $40,757) among patients with anxiety, coinciding with higher inpatient ($11,437 vs $7,872) and outpatient ($20,679 vs $15,074) costs (all p<0.05).

Conclusions: This real-world study demonstrated excess economic burden due to anxiety among Medicaid-enrolled patients with epilepsy. Special considerations are needed when managing patients with epilepsy and comorbid anxiety.

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