Comparing healthcare cost associated with the use of enzyme-inducing and non-enzyme active antiepileptic drugs in elderly patients with epilepsy in the UK: a long-term retrospective, matched cohort study

Abstract Background In elderly patients (≥65 years of age) with epilepsy who take medications for comorbid conditions, some antiepileptic drugs (AEDs) may alter the metabolism of other treatments and increase the risk of adverse consequences and healthcare utilisation. This analysis compares healthcare costs associated with enzyme-inducing AEDs (EIAEDs) and non-enzyme active AEDs (nEAAEDs) use in elderly patients with epilepsy. Methods This retrospective matched cohort study used the Clinical Practice Research Datalink (CPRD) of UK primary care medical records, linked to the Hospital Episode Statistics (HES) database. Selected patients with epilepsy were ≥ 65 years and prescribed an EIAED or nEAAED between 2001 and 2010 (index) after ≥1 year without AEDs (baseline) and followed until the first occurrence of the following: end of HES data coverage, end of GP registration, or death; practice’s up-to-standard status or addition of an AED belonging to another cohort or discontinuation of the last AED of that cohort. Propensity score matching reduced confounding factor effects between cohorts. Key outcomes included time to cohort treatment failure, time to index AED treatment failure, and direct healthcare costs in 2014 Pound Sterling (£) values. Results Overall, 1425 elderly patients were included: 964 with EIAEDs and 461 with nEAAEDs. At baseline, the EIAED cohort was older (mean age, 76.2 vs. 75.1 years) and a higher proportion were male. Baseline direct healthcare costs were similar. After matching (n = 210 each), and over the entire follow-up period, median monthly direct healthcare costs were higher for patients taking EIAEDs than nEAAEDs (£403 vs. £317; p = 0.0150, Mann-Whitney U). Costs were higher for patients remaining in the EIAED cohort after 3 follow-up years. The median time to cohort treatment failure for the EIAED cohort was 1110 days vs. 1175 days for the nEAAED cohort. Conclusion Newly treated elderly patients with epilepsy were more likely to be prescribed EIAEDs than nEAAEDs. In matched cohorts, elderly patients with epilepsy treated with EIAEDs had higher average total direct and epilepsy-related healthcare costs than nEAAED-treated patients; this difference was greater than previously reported in the overall adult population. Changing treatment practices could improve patient care and reduce costs.

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Estimating direct healthcare costs attributable to laboratory‐confirmed Lyme disease in Ontario, Canada: A population‐based matched cohort study using health administrative data

Zoonoses and Public Health ◽

10.1111/zph.12560 ◽

2019 ◽

Vol 66 (4) ◽

pp. 428-435 ◽

Cited By ~ 1

Author(s):

Emily Shing ◽

John Wang ◽

Edwin Khoo ◽

Gerald A. Evans ◽

Stephen Moore ◽

...

Keyword(s):

Cohort Study ◽

Lyme Disease ◽

Administrative Data ◽

Healthcare Costs ◽

Population Based ◽

Matched Cohort ◽

Health Administrative Data ◽

Matched Cohort Study ◽

Direct Healthcare Costs

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Influence of bone cement distribution on outcomes following percutaneous vertebroplasty: a retrospective matched-cohort study

Journal of International Medical Research ◽

10.1177/03000605211022287 ◽

2021 ◽

Vol 49 (7) ◽

pp. 030006052110222

Author(s):

Ling Mo ◽

Zixian Wu ◽

De Liang ◽

Linqiang Y ◽

Zhuoyan Cai ◽

...

Keyword(s):

Cohort Study ◽

Bone Cement ◽

Percutaneous Vertebroplasty ◽

Vertebral Compression Fractures ◽

Matched Cohort ◽

Matched Cohort Study ◽

Cement Distribution ◽

Group A ◽

Group B

Objective To evaluate the influence of insufficient bone cement distribution on outcomes following percutaneous vertebroplasty (PVP). Methods This retrospective matched-cohort study included patients 50–90 years of age who had undergone PVP for single level vertebral compression fractures (VCFs) from February 2015 to December 2018. Insufficient (Group A)/sufficient (Group B) distribution of bone cement in the fracture area was assessed from pre- and post-operative computed tomography (CT) images. Assessments were before, 3-days post-procedure, and at the last follow-up visit (≥12 months). Result Of the 270 eligible patients, there were 54 matched pairs. On post-operative day 3 and at the last follow-up visit, significantly greater visual analogue scale (VAS) pain scores and Oswestry Disability Index (ODI) scores were obtained in Group B over Group A, while kyphotic angles (KAs) and vertebral height (VH) loss were significantly larger in Group A compared with Group B. Incidence of asymptomatic cement leakage and re-collapse of cemented vertebrae were also greater in Group A compared with Group B. Conclusions Insufficient cement distribution may relate to less pain relief and result in progressive vertebral collapse and kyphotic deformity post-PVP.

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Analysis of the relationship between surgeon procedure volume and complications after total knee arthroplasty using a propensity-matched cohort study

BMJ Surgery, Interventions, & Health Technologies ◽

10.1136/bmjsit-2020-000072 ◽

2021 ◽

Vol 3 (1) ◽

pp. e000072

Author(s):

Tosan Okoro ◽

Sebastian Tomescu ◽

J Michael Paterson ◽

Bheeshma Ravi

Keyword(s):

Total Knee Arthroplasty ◽

Cohort Study ◽

Relative Risk ◽

Knee Arthroplasty ◽

Deep Infection ◽

Matched Cohort ◽

Surgical Infection ◽

Matched Cohort Study ◽

Total Knee

ObjectivesThis study aimed to identify a threshold in annual surgeon volume associated with increased risk of revision (for any cause) and deep infection requiring surgery following primary elective total knee arthroplasty (TKA).DesignA propensity score matched cohort study.SettingOntario, Canada.Participants169 713 persons who received a primary TKA between 2002 and 2016, with 3-year postoperative follow-up.Main outcome measuresRevision arthroplasty (for any cause), and the occurrence of deep surgical infection requiring surgery.ResultsBased on restricted cubic spline analysis, the threshold for increased probability of revision and deep infection requiring surgery was <70 cases/year. After matching of 51 658 TKA recipients from surgeons performing <70 cases/year to TKA recipients from surgeons with greater than 70 cases/year, patients in the former group had a higher rate of revision (for any cause, 2.23% (95% Confidence Interval (CI) 1.39 to 3.07) vs 1.70% (95% CI 0.85 to 2.55); Hazard Ratio (HR) 1.33, 95% CI 1.21 to 1.47, p<0.0001) and deep infection requiring surgery (1.29% (95% CI 0.44 to 2.14) vs 1.09% (95% CI 0.24 to 1.94); HR 1.33, 95% CI 1.17 to 1.51, p<0.0001).ConclusionsFor primary TKA recipients, cases performed by surgeons who had performed fewer than 70 TKAs in the year prior to the index TKA were at 31% increased relative risk of revision (for any cause), and 18% increased relative risk for deep surgical infection requiring surgery, at 3-year follow-up.

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Clinical and Patient-Reported Outcomes after Posterior (PLIF) versus Transforaminal Lumbar Interbody Fusion (TLIF) - A Propensity-Score Matched Cohort Study on 422 Patients with two-Year Follow-up

Spine ◽

10.1097/brs.0000000000004215 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Søren Ohrt-Nissen ◽

Leah Y. Carreon ◽

Andreas K. Andresen ◽

Mikkel O. Andersen ◽

Peter Udby

Keyword(s):

Cohort Study ◽

Propensity Score ◽

Patient Reported Outcomes ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Matched Cohort ◽

Matched Cohort Study ◽

Patient Reported

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Differential cerebrovascular risks in glioblastoma and meningioma patients: a population-based matched cohort study in Wales (United Kingdom)

Neuro-Oncology ◽

10.1093/neuonc/noab195.028 ◽

2021 ◽

Vol 23 (Supplement_4) ◽

pp. iv12-iv12

Author(s):

Michael T C Poon ◽

Kai Jin ◽

Paul M Brennan ◽

Jonine Figueroa ◽

Cathie Sudlow

Keyword(s):

Cohort Study ◽

General Population ◽

Ischaemic Stroke ◽

Population Based ◽

Parametric Models ◽

Matched Cohort ◽

Matched Cohort Study ◽

Hazard Ratios ◽

History Of

Abstract Aims There is limited evidence on cerebrovascular risks in glioblastoma and meningioma patients. We aimed to compare cerebrovascular risks of these patients with the general population. Method We used population-based routine healthcare and administrative data linkage in this matched cohort study. Cases were adult glioblastoma and meningioma patients diagnosed in Wales 2000-2014 identified in the cancer registry. Controls from cancer-free general population were matched to cases (5:1 ratio) on age (±5 years), sex and GP practice. Factors included in multivariable models were age, sex, index of multiple deprivation, hypertension, diabetes, high cholesterol, history of cardiovascular disease, and medications for cardiovascular diseases. Outcomes were fatal and non-fatal haemorrhagic and ischaemic stroke. We used flexible parametric models adjusting for confounders to calculate the hazard ratios (HR). Results Final analytic population was 16,921 participants, of which 1,340 had glioblastoma and 1,498 had meningioma. The median follow-up time was 0.5 year for glioblastoma patients, 4.9 years for meningioma patients, and 6.6 years for controls. The number of haemorrhage and ischaemic stroke was 154 and 374 in the glioblastoma matched cohort, respectively, and 180 and 569 in the meningioma matched cohort, respectively. The adjusted HRs for haemorrhagic and ischaemic stroke were 3.74 (95%CI 1.87-6.57) and 5.62 (95%CI 2.56-10.42) in glioblastoma patients, respectively, and were 2.42 (95%CI 1.58-3.52) and 1.86 (95%CI 1.54-2.23) in meningioma patients compared with their controls. Conclusion Glioblastoma and meningioma patients had higher cerebrovascular risks; these risks were even higher for glioblastoma patients. Further assessment of these potentially modifiable risks may improve survivorship.

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Arthroscopic management with labral preservation, femoral osteoplasty, and capsular plication in patients with borderline hip dysplasia. Results of a matched-cohort study at minimum two year follow-up

International Orthopaedics ◽

10.1007/s00264-020-04810-8 ◽

2020 ◽

Vol 44 (12) ◽

pp. 2567-2575

Author(s):

Jesus Mas Martinez ◽

Javier Sanz-Reig ◽

Carmen Verdu Roman ◽

Enrique Martinez Gimenez ◽

Manuel Morales Santias ◽

...

Keyword(s):

Cohort Study ◽

Hip Dysplasia ◽

Matched Cohort ◽

Arthroscopic Management ◽

Matched Cohort Study ◽

Capsular Plication ◽

Femoral Osteoplasty

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1402. Long-Term Mortality and Epilepsy in Patients After Brain Abscess: A Nationwide Population-based Matched Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1266 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S510-S510

Author(s):

Jacob Bodilsen ◽

Michael Dalager-Pedersen ◽

Diederik van de Beek ◽

Matthijs C Brouwer ◽

Henrik Nielsen

Keyword(s):

Cohort Study ◽

Brain Abscess ◽

Cox Regression ◽

Population Based ◽

Matched Cohort ◽

Matched Cohort Study ◽

Population Controls ◽

New Onset

Abstract Background The long-term outcome of brain abscess is unclear. Methods We used medical registries to conduct a nationwide population-based matched cohort study to examine the long-term risks of mortality and new-onset epilepsy in patients hospitalized with brain abscess in Denmark from 1982 through 2016. Comparison cohorts from the same population individually matched on age, sex, and residence were identified, as were siblings of all study participants (Figure 1). We computed cumulative incidences and hazard rate ratios (HRRs) for mortality and new-onset epilepsy among brain abscess patients, comparison cohorts and siblings. Population and appendicitis controls had similar characteristics and prognosis why only comparisons between brain abscess patients and population controls are detailed here. Results We identified 1,384 brain abscess patients with a median follow-up time of 5.9 years (IQR 1.1–14.2). The 1-year, 2–5 year, and 6–30-year mortality of patients after brain abscess was 21%, 16% and 27% when compared with 1%, 6% and 20% for matched population controls (Figure 2). Cox regression analyses adjusted for Charlson comorbidity index score showed 1-year, 2–5 year, and 6- to 30-year HRRs of 17.5 (95% CI 13.9–22.2), 2.61 (95% CI 2.16–3.16) and 1.94 (95% CI 1.62–2.31). The mortality in brain abscess patients compared with population controls was significantly increased regardless of sex or age group except among subjects 80 years or older, and in both previously healthy individuals and immuno-compromised persons. Among the 30-day survivors of brain abscess (median follow-up 7.6 years [IQR 2.2–15.5]), new-onset epilepsy occurred in 32% compared with 2% in matched population controls. Cause-specific Cox regression analysis adjusted for stroke, head trauma, alcohol abuse, and cancer showed 1-year, 2–5-year, and 6–30-year HRRs for new-onset epilepsy of 155 (95% CI 78.8–304), 37.7 (95% CI 23.0–59.9), and 8.93 (95% CI 5.62–14.2) (Figure 3). Comparisons between sibling cohorts suggested no substantial effect of family-related factors on the long-term risk of death or epilepsy after brain abscess (Figure 4). Conclusion Brain abscess is associated with an increased long-term risk of mortality and new-onset epilepsy for several years after the acute infection. Disclosures All authors: No reported disclosures.

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