AT AES 2016

HOUSTON (FRONTLINE MEDICAL NEWS) – The types of diagnostic tests ordered and medication used for treatment of infantile spasms vary considerably, a large study of children’s hospitals showed.

“Children with infantile spasms often require extensive diagnostic work-up to determine etiology, expensive medications for treatment, and hospitalization during the initiation of certain therapies,” researchers led by Sunita N. Misra, MD, PhD, wrote in an abstract presented at the annual meeting of the American Epilepsy Society. “The common diagnostic studies and therapies have evolved over the last several decades.”

In an effort to determine trends of treatment for infantile spasms at children’s hospitals, including cost and initial diagnostic work-up, Dr. Misra, a child neurology resident at Baylor College of Medicine, Houston, and her associates retrospectively evaluated the Pediatric Health Information System (PHIS) to identify patients 2 years of age or younger with infantile spasms who were admitted as inpatients during 2004-2014. The PHIS contains inpatient, emergency department, ambulatory surgery, and observation data from 43 not-for-profit, tertiary care pediatric hospitals in the United States.

The researchers collected patient demographics, hospital length of stay, hospital admission cost, use of various diagnostic studies (such as lumbar puncture, brain MRI, and EEG), and medications used for infantile spasms (including antiepileptic drugs, corticotropin, and steroids). Cost data, calculated as a ratio of cost to charges, were collected and adjusted to 2014 dollars.

A total of 6,183 patients were included in the analysis and their average age of infantile-spasm diagnosis was 9 months. The most common diagnostic test ordered was EEG (76%), followed by brain imaging (57%), organic acids (38%), and lumbar puncture (17%). Medications were started during inpatient hospitalization in two-thirds of patients, with 33% starting on corticotropin; 29% on topiramate; and fewer than 10% of patients on an oral or intravenous steroid, zonisamide, or vigabatrin (Sabril). Use of corticotropin decreased over time, while use of oral steroids trended upwards. “We were surprised that one-third of patients did not have a medication initiated as an inpatient, given the studies showing earlier use of effective therapy has better outcomes,” Dr. Misra said in an interview in advance of the meeting.

Length of stay was a mean of 5.8 days, with an overall adjusted cost of $18,348. The researchers observed an increase in cost over time, from a mean of $12,534 in 2004 to $23,391 in 2014. This correlated with an increase in mean length of stay over time from a mean of 5.2 days in 2004 to 6.9 days in 2014. Multivariate analysis demonstrated statistically significant associations with increased cost for length of stay and days of corticotropin therapy (P less than .05 for all associations), while lumbar puncture and zonisamide demonstrated decreased cost.

“The cost of taking care of children with infantile spasms has increased over the study period 2004-2014,” Dr. Misra said. “Although we identified a few contributors to rising cost, there are probably other factors that need to be considered in future studies.” She acknowledged certain limitations of the analysis, including its retrospective design and the fact that it only identified cost associated with the initial admission. “Several of the diagnostic studies and medications may be initiated as an outpatient, for which we do not have the data,” she said.

Dr. Misra reported having no financial disclosures.