Newer antiepileptic drug use and other factors decreasing hospital encounters

•Second-generation antiepileptic drugs reduce frequency of epilepsy-related hospital encounters.•The observation is not affected by patient age or sex or by geographic region.•Antiepileptic drug choice has greater impact on patients with more comorbidities.•Neurologists are more likely to prescribe a second-generation antiepileptic drug.•Changing medication after a hospitalization delays the next hospital encounter.

A retrospective analysis was conducted in one claims database and was confirmed in a second independent database (covering both commercial and government insurance plans between 11/2009 and 9/2011) for the understanding of factors influencing antiepileptic drug (AED) use and the role of AEDs and other health-care factors in hospital encounters. In both datasets, epilepsy cases were identified by AED use and epilepsy diagnosis coding. Variables analyzed for effect on hospitalization rates were as follows: (1) use of first-generation AEDs or second-generation AEDs, (2) treatment changes, and (3) factors that may affect AED choice. Lower rates of epilepsy-related hospital encounters (encounters with an epilepsy diagnosis code) were associated with use of second-generation AEDs, deliberate treatment changes, and treatment by a neurologist. Epilepsy-related hospital encounters were more frequent for patients not receiving an AED and for those with greater comorbidities. On average, patients taking ≥ 1 first-generation AED experienced epilepsy-related hospitalizations every 684 days, while those taking ≥ 1 second-generation AED were hospitalized every 1001 days (relative risk reduction of 31%, p < 0.01). Prescriptions for second-generation AEDs were more common among neurologists and among physicians near an epilepsy center. Use of second-generation AEDs, access to specialty care, and deliberate efforts to change medications following epilepsy-related hospital encounters improved outcomes of epilepsy treatment based on average time between epilepsy-related hospital encounters. These factors may be enhanced by public health policies, private insurance reimbursement policies, and education of patients and physicians.