Seizure frequency, healthcare resource utilisation, and mortality in childhood epilepsy: a retrospective cohort study using the THIN database

Objective: To understand the association of seizure frequency with healthcare resource utilisation (HCRU) and mortality in UK children with epilepsy (CWE). Design: Retrospective cohort study. Setting: Routinely collected data in primary care from The Health Improvement Network (THIN) UK database. Patients: CWE ≥1 and <18 years of age with a record of seizure frequency were included in mortality analyses from 2005-2015 and HCRU analyses from 2010-2015. Main outcome measures: Frequency of HCRU contacts during the year following latest seizure frequency and mortality (descriptive and Cox proportional hazards regression) from first record of seizure frequency. Results: Higher seizure frequency was related to increased HCRU utilisation and mortality. In negative binomial regression, each category increase in seizure frequency related to 11% more visits to general practitioners, 35% more in-patient admissions, 15% more outpatient visits, and increased direct HCRU costs (24%). Eleven patients died during 12,490 patient-years follow-up. The unadjusted hazard ratio of mortality per higher category of seizure frequency was 2.56 (95% CI 1.52 to 4.31). Adjustment for age and number of prescribed anti-epileptic drugs at index attenuated this estimate to 2.11 (95% CI 1.24 to 3.60). Conclusion: Higher seizure frequency is associated with greater HCRU and mortality in CWE in the UK. Improvement in seizure control may potentially lead to better patient outcomes and reduced healthcare use.