The association of multiple chronic conditions and healthcare expenditures among adults with epilepsy in the United States.

RATIONALE: Epilepsy is a frequent neurologic condition with important financial strains on the US healthcare system. The co-occurrence of multiple chronic conditions (MCC) may have additional financial repercussions on this patient population. We aimed to assess the association of coexisting chronic conditions on healthcare expenditures among adult patients with epilepsy. METHODS: We identified a total of 1,942,413 adults (≥18 years) with epilepsy using the clinical classification code 83 from the MEPS-HC (Medical Expenditure Panel Survey Household Component) database between 2003 and 2014. Chronic conditions were selected using the clinical classification system (ccs), and categorized into 0, 1, or 2 chronic conditions in addition to epilepsy. We computed unadjusted healthcare expenditures per year and per individual (total direct healthcare expenditure, inpatient expenditure, outpatient expenditure, prescription medication expenditure, emergency room visit expenditure, home healthcare expenditure and other) by number of chronic conditions. We applied a two-part model with probit (probability of zero vs non-zero cost) and generalized linear model (GLM) gamma family and log link (for cost greater than zero) to examine the independent association between chronic conditions, and annual expenditures per individual, generating incremental costs with 0 chronic condition as reference. RESULTS: Over half of the patients with epilepsy had at least two chronic conditions (CC). Yearly, for each patient with one and two chronic conditions, unadjusted total healthcare expenditures were two times ($10,202; 95 %CI $6,551-13,853) to nearly three times ($21,277; 95 %CI $12,971-25,583) higher than those with no chronic conditions ($6,177; 95 %CI $4,895-7,459), respectively. In general healthcare expenditures increased with the number of chronic conditions for pre-specified cost categories. The incremental (adjusted) total healthcare expenditure increased with the number of chronic conditions (1CC vs 0 CC: $3,238; 95 %CI $524-5,851 p-value = 0.015 and ≥2 CC vs 0 CC: $8,145; 95 %CI $5,935-10,895 p-value < 0.001). In general, for all cost categories, incremental healthcare expenditures increased with the number of chronic conditions with the largest increment noted between those with 2 CC and those with 0 CC for inpatient ($2,025: 95 %CI $867-3,1830), outpatient ($2,141; 95 %CI $1,321-2,962), and medication ($1,852; 95 %CI $1,393-2,310). CONCLUSION: Chronic conditions are frequent among adult patients with epilepsy and are associated with a dose-response increase in healthcare expenditure, a difference driven by inpatient, outpatient, and medication prescription expenditures. Greater coordination of epilepsy care accounting for the presence of multiple chronic conditions may help lower the cost of epilepsy.

Prevalence, predictors, and prognosis of mortality among elderly stroke patients with convulsive status epilepticus in the United States.

BACKGROUND: Stroke is the most common cause of epilepsy in the elderly. However, despite the high mortality typically associated with convulsive status epilepticus (CSE), there is a dearth of nationwide data on the magnitude and association of CSE with mortality among hospitalized elderly with stroke in the United States. METHODS: We analyzed the 2006-2014 National Inpatient Sample (NIS) to identify elderly patients (65+ years) with a primary discharge diagnosis of stroke using the International Classification of Diseases, Ninth Revision-Clinical Modification (ICD-9-CM) codes 433.X1, 434.X1, 436, 430, 431, 432.0, 432.1, and 432.9. We examined a subgroup with a secondary discharge diagnosis of convulsive status epilepticus (ICD-9-CM: 345.3). We estimated the hospital mortality rate by CSE status and then evaluated the independent association of CSE and other key factors with mortality among hospitalized elderly with stroke. RESULTS: A total of 1220 elderly patients (0.14%) had a secondary discharge diagnosis of CSE. Inpatient mortality rate was 25.8% among those with CSE vs. 7.7% for non-CSE patients. CSE was independently associated with a 4-fold increased odds of in-hospital death. Increased age, medical comorbidities, weekend admissions, being a Medicare beneficiary, and hospitalization in large urban teaching hospitals were also independently associated with a greater likelihood of in-hospital death. The small number of events did not allow analysis by stroke subtypes. CONCLUSION: While CSE occurs in just 14 of 10,000 hospitalized elderly stroke patients in the United States, it is associated with a 4-fold higher odds of in-hospital death.

Racial Disparities in Ischemic Stroke Among Patients with COVID-19 in the United States.

BACKGROUND: Cerebrovascular prevalence is high in patients with coronavirus disease 2019 (COVID-19). However, whether racial disparities exist among this population have not been systematically explored. METHODS: We performed a retrospective study to assess the prevalence of stroke stratified by race among patients aged 18 years or older with COVID-19 who visited emergency department (ED) up to August 13, 2020 in the United States (US). We used multivariable logistic regression to compare the odds of stroke in Black patients with COVID-19 compared to their non-Black counterparts while adjusting for the major potential confounders. RESULTS: Among 8815 patients with ED visits with COVID-19, 77 (0.87%), 95% confidence interval CI (95% CI): 0.69% to 1.10%) had ischemic stroke. The mean age of patients with stroke was 64 years (SD: 2 years); 28 (43%) were men, 55 (71%) had hypertension, and 29 (50%) were Black. The prevalence of ischemic stroke in Blacks, non-Hispanic Whites and Hispanics was 1.26% (95% CI: 0.86% to 1.83%), 0.84% (95% CI: 0.51% to 1.37%) and 0.49% (95% CI: 0.26% to 0.88%) respectively. After adjustment for age, sex, hypertension, diabetes, obesity, drinking and smoking, the likelihood of stroke was higher in Black than non-Black patients (adjusted odds ratio, 2.76; 95% CI, 1.13 to 7.15, p=0.03). CONCLUSIONS: Racial disparities in the prevalence of stroke among patients with COVID-19 exist, higher in Black population.

Contemporary relationship between medical expenditures and quality of life among adults with epilepsy in the United States.

AIMS: Epilepsy exacts substantial adverse economic and quality of life (QoL) costs. Clarifying the quantitative and qualitative relationships between total and out-of-pocket (OOP) healthcare expenditures and QoL could shed insights into how they influence each other, and have done so over recent times. METHODS: We used the Medical Expenditure Household Components 2003-2014 to identify a total of 2450 adults with epilepsy, representing a weighted population of 1,942,413. Quality of life was assessed using the Physical Component Summary (PCS) and the Mental Component Summary (MCS) derived from the Short-form 12 Version 2 (SF-12 V2), converted into quartiles of equal distribution, with higher quartiles indicating a better QoL. We computed unadjusted mean and adjusted (through a generalized linear model (GLM)) total and OOP healthcare expenditures by QoL categories among adults with epilepsy (reported as dollars in 2016). RESULTS: The pooled estimates of total healthcare expenditures decreased as PCS and MCS quartiles of QoL increased [PCS: costs for quartile 1 = $21,792 (95% confidence interval (CI): $18,416-$25,168 vs. costs for quartile 4 = $6057 (95% CI: $4648-$7466) and MCS: costs for quartile 1 = $19,040 (95% CI: $15,544-$22,535) vs. quartile 4 = $12,939 (95% CI: $8450-$17,429)]. Similarly, the pooled estimates of OOP healthcare expenditures and QoL were inversely related [PCS: costs for quartile 1 = $1849 (95% CI: $1583-$2114) vs. costs for quartile 4 = $948 ($709-$1187) and MCS: costs for quartile 1 = 1812 (95% CI: $1483-2141) vs. quartile 4 = $1317 (95% CI: $982-$1652)]. The association between QoL and total and OOP healthcare expenditures was unchanged after adjusting for socioeconomic and healthcare system related confounders in the GLM. Overall, healthcare expenditures were stable across years independently of the QoL; only OOP expenditures decreased between 2003-2006 and 2011-2014 for quartile 1 of PCS and MCS. CONCLUSION: Quality of life and OOP health expenditures are independently and inversely related to each other among adults with epilepsy. Over the decade studied in the United States, there was a decrease in OOP health expenditures among those patients with epilepsy with the lowest QoL, possibly reflecting a rise in insurance coverage after the Affordable Care Act.

Enzyme-inducing antiseizure medication utilization in patients with epilepsy and vascular risk factors.

OBJECTIVES: Several lines of evidence have suggested that exposure to enzyme-inducing antiseizure medications (EIASMs) may result in the subsequent development of hyperlipidemia, a well-known risk factor for vascular disease. This may be an issue of concern particularly in the context of additional comorbid vascular risk factors. We therefore aimed to investigate trends of and associations with the use of these medications among adult patients with epilepsy. METHODS: The cross-sectional Medical Expenditure Panel Survey (MEPS) was interrogated to ascertain the prevalence of use of EIASMs by noninstitutionalized adult patients with epilepsy in the United States between the years 2004 and 2015. Any patient prescribed carbamazepine, phenytoin, phenobarbital, or primidone within a given year was defined as having been prescribed an EIASM. Trends over three-year epochs were evaluated with univariate logistic regression, while associations with demographic factors, vascular risk factors, and vascular disease were evaluated using a chi-square test corrected for survey design as well as multivariate logistic regression. RESULTS: A total of 2281 (unweighted) patients were identified, representing 1,781,237 individuals. Between 2004 and 2015, 45.9% (95% confidence interval [CI]: 42.4%-49.4%) were prescribed EIASMs. Approximately one-quarter of patients aged 65 years and above used EIASMs compared with 18.5% of younger patients (odds ratio [OR]: 1.83, 95% CI = 1.27-2.65). Female patients (OR = 0.61, 95% CI = 0.47-0.79) and those with heart disease (OR: 0.63, 95% CI = 0.45-0.89) were significantly less likely to be prescribed EIASMs. Among those prescribed EIASMs, 38.9% had hypertension, 12.2% had diabetes, 61.6% were overweight or obese, 17.3% heart disease, 17.2% had a history of a cerebrovascular event, and 28.5% had diagnosed hyperlipidemia. Nonetheless, between 2004-2006 and 2013-2015, the odds of EIASM prescription decreased significantly (OR: 0.39, 95% CI: 0.28-0.55). CONCLUSIONS: A substantial proportion of patients with comorbid vascular disease or vascular risk factors (e.g., hypertension and older age) is prescribed EIASMs. This could potentially increase patients' risk for subsequent negative outcomes such as cardiovascular or cerebrovascular disease. Though utilization of these medications has decreased, further efforts toward increasing use of newer antiseizure medications (ASMs) that are not associated with similar risks may be warranted.

Estimating the Economic Burden of Acute Myocardial Infarction in the US: 12 Year National Data.

BACKGROUND: Acute myocardial infarction (AMI) carries a substantial mortality and morbidity burden. The purpose of this study is to provide annual mean cost per patient and national level estimates of direct and indirect costs (lost productivity from morbidity and premature mortality) associated with AMI. METHODS: Nationally representative data spanning 12 years (2003-2014) with a sample of 324,869 patients with AMI from the Medical Expenditure Panel Survey (MEPS) were analyzed. A novel 2-part model was used to examine the excess direct cost associated with AMI, controlling for covariates. To estimate lost productivity from morbidity, an adjusted Generalized Linear Model was used for the differential in wage earnings between participants with and without AMI. Lost productivity from premature mortality was estimated based on published data. RESULTS: The total annual cost of AMI in 2016 dollars was estimated to be $84.9 billion, including $29.8 billion in excess direct medical expenditures, $14.6 billion in lost productivity from morbidity and $40.5 billion in lost productivity from premature mortality between 2003 and 2014. In the adjusted regression, the overall excess direct medical expenditure of AMI was $7,076 (95% confidence interval [CI] $6,028-$8,125) higher than those without AMI. After adjustment, annual wages for patients with AMI were $10,166 (95% CI -$12,985 to -$7,347) lower and annual missed work days were 5.9 days (95% CI 3.57-8.27) higher than those without AMI. CONCLUSIONS: The study finds that the economic burden of AMI is substantial, for which effective prevention could result in significant health and productivity cost savings.

A contemporary and comprehensive analysis of the costs of stroke in the United States.

BACKGROUND: While several studies have determined direct costs associated with stroke there is a paucity of research involving indirect costs, especially in younger patients. AIM: Perform a cost of illness analysis for ischemic and non-traumatic hemorrhagic stroke in the US involving both direct and indirect costs in all age groups. METHODS: Nationally representative data was obtained from the Medical Expenditure Panel Survey (2003-2014). Subjects were dichotomized based on reported history of stroke. Two-part econometric models were used to estimate the adjusted incremental direct expenditure for patients with stroke. We used generalized linear model with family gamma, log link for the adjusted analysis of annual wage, a negative binomial regression model for the adjusted analysis of missed-work day, and a logistic regression model to estimate the probability of full-year employment. Loss of productivity due to premature death was computed using Present-Value of one life and annual number of deaths from 2014 National Vital Statistics. All costs are represented in 2016 US-dollar values. RESULTS: Out of 253,235,052 participants, 8,101,159 (3.2%) reported history of stroke. Weighted samples of 10,155 stroke participants and 314,694 control group were compared. Adjusted annual direct costs for each stroke participant was $4317 (95% CI: $3828-$4807) greater than control resulting in a net $38 billion incremental expenditure. Based on salary difference, missed workdays, and mortality, indirect cost from under-employment was $38.1 billion and from premature mortality was $30.4 billion. CONCLUSION: Total aggregate of $103.5 billion expenditure was incurred with 66% being from indirect costs based on 2016 US-dollar values.

Costs and cost-drivers of a diagnosis of depression among adults with epilepsy in the United States.

OBJECTIVE: The objective of this study was to evaluate the amount of direct costs associated with occurrence of depression in people with epilepsy. METHODS: The Medical Expenditure Panel Survey Household Components (MEPS-HC) served as data source to identify adults (≥18 years) with epilepsy from 2003 to 2014, using the Clinical Classification Code CCC-83. Annual unadjusted per person total healthcare expenditures and individual cost components (inpatient, outpatient, prescription, emergency room, and home health) were compared between people with epilepsy and depression vs. without depression. A two-part model estimated the adjusted incremental direct cost of depression (total and individual cost components) among adults with epilepsy. The model was adjusted for sex, race/ethnicity, education, marital status, insurance status, census region, income, Charlson Comorbidities index (CCI), and year trend. RESULTS: Out of a weighted 1,942,413 US adults with epilepsy, 675,037 (34.7%) had a diagnosis of depression. Annual total unadjusted per person direct cost of depression was $5290 higher in people with epilepsy vs. without [$18,776 (95% confidence interval [CI]: 16,241-21,311) vs. $13,486 (95%CI: 9780-17,191)]. Costs for outpatient and prescriptions were higher among people with epilepsy plus depression vs. without depression, but no differences were observed for inpatient, emergency room, and home health costs. In the adjusted model, total costs [$2523 (95%CI: 62-4984)], incremental annual direct costs per person for outpatient [$1940 (95%CI: 1266-2613)], prescriptions [$1285 (95%CI: 772-1798)], and emergency room [$191 (95%CI: 20-361)] were significantly higher for people with epilepsy plus depression. Unadjusted and adjusted incremental total aggregate annual direct costs of depression for people with epilepsy were $3.5 billion and $1.7 billion respectively. CONCLUSION: Costs of epilepsy with presence of depression in the US are high, and primarily driven by outpatient, prescriptions, and emergency room costs.

Association of office-based provider visits with emergency department utilization among publicly insured stroke survivors.

OBJECTIVE: To evaluate the association between visits to office-based providers and Emergency Department (ED) utilization among stroke survivors. METHODS: We analyzed 12-years of data representing a weighted sample of 3,317,794 publicly insured US adults aged ≥18 years with stroke, using the Medical Expenditure Panel Survey Household Component (MEPS-HC), 2003-2014 dataset. We used a negative binomial regression model that accounts for dispersion to estimate the association between office-based and ED visits controlling for covariates. We used a multivariate logistic regression model to identify independent predictors of ED visits. RESULTS: Annual mean (SD) ED visits and office based visits for publicly insured stroke survivors were 0.60 (1.10) and 12.2 (19.9) respectively. Each unit increase in office based visits was associated with a 1% increase in ED visit (p = 0.008). Being unmarried (adjusted OR = 1.26; 95% CI: 1.015-1.564) and having several comorbidities (adjusted OR = 1.93; 95% CI: 1.553-2.412) were associated with a higher likelihood of at least one ED visit. The odds for an ED visit for individuals aged 45-64, those aged 65 years and above, and those with a college or higher level of education were respectively 34% (OR = 0.66; 95% CI: 0.454-0.965), 52% (OR = 0.48; 95% CI: 0.330-0.701), and 36% (OR = 0.64; 95% CI: 0.497-0.834) lower than their counterparts. CONCLUSIONS: Contrary to our expectations, there was a direct relationship between ED visits and office base visits among U.S. stroke survivors. This finding may reflect the difficulties associated with managing stroke survivors with multiple co-morbidities or complex psycho-socio-economic issues.

Health care expenditures among elderly patients with epilepsy in the United States.

OBJECTIVE: The purpose of this study was to evaluate health care expenditures among elderly patients with epilepsy in the United States. METHODS: We performed an analysis of weighted 37 738 607 US participants aged 65 years to estimate health care expenditures in the elderly with and without epilepsy using the Medical Expenditure Panel Survey Household Component, with 2003-2014 data. Unadjusted health care expenditures were estimated. Independent health care expenditures were estimated, using a 2-part model. RESULTS: We identified 416 496 (1.1%) older individuals with epilepsy. Comorbidities were more prevalent among older individuals with epilepsy versus younger individuals. Mean unadjusted yearly medical cost of epilepsy in elderly patients with epilepsy was $18 712 (95% confidence interval [CI] = $15 947-$21 476) during the pooled period 2003-2014, which was nearly double the equivalent cost in elderly subjects without epilepsy at $10 168 (95% CI = $9925-$10 410). Mean unadjusted annual medical cost of epilepsy in the elderly increased by $2135 from $15 850 (95% CI = $10 668-$21 032) in 2003-2006 to $17 985 (95% CI = $13 710-$22 260) in 2011-2014. Adjusted mean total health care expenditures per person per year for elderly patients with epilepsy were $12 526 in 2003-2006, $13 423 in 2007-2010, and $10 569 in 2011-2014. Adjusted incremental health care costs associated with epilepsy in the elderly accrued by $4595 (95% CI = $2399-$6791) when compared to elderly subjects without epilepsy. We estimated the mean annual aggregate cost of epilepsy at $7.8 billion to the US population. SIGNIFICANCE: Epilepsy is common among elderly individuals, and health care expenditures among this growing group are 2 times higher than in those without epilepsy.

The direct cost of epilepsy in children: Evidence from the Medical Expenditure Panel Survey, 2003-2014.

INTRODUCTION: Epilepsy is frequent in children and often requires complex healthcare interventions. There is a paucity of recent and detailed healthcare expenditures among children with epilepsy in the United States (US). METHODS: Data on children (aged ≤17years) from the Medical Expenditure Panel Survey-Household Component (MEPS-HC) from 2003 to 2014 were analyzed. Unadjusted overall and specific cost components were compared between children with epilepsy and those without epilepsy. We used a two-part model with gamma distribution and log link for the estimation of independent incremental cost incurred by epilepsy in children. Unadjusted and adjusted mean expenditures and aggregate burden of epilepsy were estimated. RESULTS: Out of 54,393,387 (weighted) US children, 457,873 (0.84%) had epilepsy. Children with epilepsy had nearly six times higher healthcare expenditure than those without epilepsy ($2024 [95% confidence interval (CI): 1917-2130] vs. $12,577 [95% CI: 7922-17,231]). Unadjusted inpatient expenditure for epilepsy ($4418 [95% CI: 1550-7285) was ten times higher than that for children without epilepsy, representing more than one-third of unadjusted total direct cost. The adjusted difference in medical expenditure between children with and those without epilepsy was $8317 (95% CI: 3701-13,363). The annual unadjusted aggregate cost of epilepsy in children was approximately $5.8 billion. The annual adjusted difference in cost of epilepsy between children with and those without epilepsy was $3.8 billion. CONCLUSION: Unadjusted and adjusted medical expenditure among children with epilepsy is high. The high expenditure is essentially driven not only by inpatient expenditure but also by home healthcare, outpatient, and medication healthcare expenditures.

Nationwide Healthcare Expenditures among Hypertensive Individuals with Stroke: 2003-2014.

BACKGROUND: Of all the various clinical entities, hypertension is arguably most strongly linked to the occurrence of stroke. However, the impact of stroke on health-care expenditures in patients with hypertension has not been previously evaluated. METHODS: We analyzed data from the Medical Expenditure Panel Survey Household Component, 2003-2014 data. Adults aged 18 years or greater were included in this analysis. We used a 2-part model (adjusting for demographic, comorbidity, and time) to estimate the incremental health-care expenditures incurred by stroke among individuals with hypertension. RESULTS: On average, $4057 more dollars (adjusted incremental health-care expenditure) was spent on individuals with hypertension plus stroke versus no history of stroke. Overall unadjusted mean medical expenditure in those with a comorbid diagnosis of stroke was twice as high as in those without a diagnosis of stroke ($16,668 versus 8374; P < .001). Inpatient expenditures (37.4%), outpatient expenditures, and prescription expenditures (nearly 23% each) accounted for almost 80% of the total mean unadjusted direct expenditures. Annual average unadjusted aggregate costs among individuals with hypertension and stroke were $98.3 billion, while annual adjusted aggregate incremental costs were higher by $24 billion among patients with stroke versus those without stroke. CONCLUSION: Among individuals with hypertension in the United States, those who have experienced a stroke incur tens of billions of dollars in higher health-care expenditures compared with those without known stroke. Greater emphasis on stroke prevention strategies and cost control initiatives (wherever appropriate) are warranted.

Nationwide Healthcare utilization among children with epilepsy in the United States: 2003-2014.

BACKGROUND: Epilepsy is particularly frequent among children, yet updated and nationwide healthcare utilization estimates are scanty in the United States. OBJECTIVE: To analyze healthcare utilization among children with epilepsy. METHODS: Data on children (≤17-year-old) were extracted from the Medical Expenditure Panel Survey (MEPS) 2003-2014. Epilepsy was identified using the clinical classification code 83. Healthcare utilization (Inpatient admission, outpatient visits, prescription medication including refill, emergency room visits, and home health provider visits) was compared between children with epilepsy and those without epilepsy. A negative binomial model was used to assess the relationship between epilepsy and healthcare utilizations accounting for the influence of extraneous factors. RESULTS: In all, a weighted 457,873 children (0.84%) had epilepsy in United States. The unadjusted proportion and the mean annual number of health care service utilization were higher in children with epilepsy compared to those without epilepsy. Children with epilepsy had almost 3.3 more outpatient visits (95% CI: 2.281-4.274), 7.9 more medication prescriptions including refills (95% CI: 6.058-9.662), nearly 0.4 more emergency department visits (95% CI: 0.278-0.438) and nearly 12 more home health provider visits (95% CI: 1.988-21.756) than those without epilepsy. The adjusted marginal effect of epilepsy on inpatient admission was not statistically significant. CONCLUSION: unadjusted and adjusted healthcare utilization is considerably higher in children with epilepsy compared to those without epilepsy in the United States with heterogeneity across individual services.

Relationship between office-based provider visits and emergency department encounters among publicly-insured adults with epilepsy.

INTRODUCTION: The proportion of adults with epilepsy using the emergency department (ED) is high. Among this patient population, increased frequency of office-based provider visits may be associated with lesser frequency of ED encounters, and key patient features may be linked to more ED encounters. METHODS: We analyzed the Medical Expenditure Panel Survey Household Component (MEPS-HC) dataset for years 2003-2014, which represents a weighted sample of 842,249 publicly-insured US adults aged ≥18years. The Hurdle Poisson model that accommodates excess zeros was used to estimate the association between office-based and ED visits. RESULTS: Annual mean ED and office-based visits for publicly-insured adults with epilepsy were 0.70 and 10.8 respectively. Probability of at least one ED visit was 0.4% higher for every unit of office-based visit. Individuals in the high income category were less likely to visit the ED at least once while women with epilepsy had a higher likelihood of visiting the ED at least once. Among those who visited the ED at least once, there was a 0.3% higher likelihood of visiting the ED for every unit of office-based visit. Among individuals who visited the ED at least once, being aged 45-64years, residing in the West, and the year 2011/14 were associated with higher ED visits. CONCLUSION: In this representative sample of publicly-insured adults with epilepsy, higher frequency of office visits was not associated with lower ED utilization, which may be due to underlying greater disease severity or propensity for more treatment complications.

Nationwide trends in medical expenditures among adults with epilepsy: 2003-2014.

OBJECTIVE: Healthcare expenditure among adults with epilepsy is high. There is a paucity of published data on trends in the nationwide economic impact of epilepsy. This study examines trends in healthcare expenditures and components in U.S. adults with epilepsy between 2003 and 2014. METHODS: We analyzed 12years of data representing a weighted sample of 1,942,413U.S. adults aged ≥18years with epilepsy using Medical Expenditure Panel Survey Household Component (MEPS-HC), 2003-2014 data. We used a novel two-part model (adjusting for demographic, comorbidity, and time) to estimate the incremental healthcare expenditures by epilepsy status. Pre and post Affordable Care Act era costs were compared. RESULTS: Overall unadjusted annual mean medical expenditures for patients with epilepsy was $15,324. Individuals with epilepsy had nearly three times higher overall unadjusted mean expenditure than those without epilepsy ($15,324, 95%CI: 2778-17,871 vs. $5824, 95%CI: 5722-5926). The unadjusted annual mean medical expenditure decreased over time from $17,994 (95% CI $10,754-$25,234) in 2003/2006 to $13,848 (95% CI: $11,371-$16,324) in 2011/2014; a trend driven primarily by a decrease in inpatient expenditures from $5613 to $4113. Having a diagnosis of epilepsy increased health expenditure by $8598 which was 2.5 to 6 times greater than the equivalent incremental health expenditures for other selected comorbidities. Healthcare expenditure among adults with epilepsy was $4083 lower in the post- Affordable Care Act. CONCLUSION: Over the last decade, individuals with epilepsy incurred significantly higher medical expenditures than those without epilepsy, but overall healthcare expenditure decreased over time due to a decrease in inpatient expenditures.