Characterization, healthcare resource utilization, and costs of health equity clusters of Medicaid-insured patients with epilepsy: An exploratory machine learning approach.

Authors

Herbert Peeples, Keshia Maughn, Christopher Dieyi, Emily Achter

Published in

Epilepsy research. Volume 227. Pages 107866. Jul 04, 2026. Epub Jul 04, 2026.

Abstract

Identify health equity clusters among Medicaid enrollees and describe their characteristics and economic burden.
De-identified data of Medicaid-insured adults with epilepsy prescribed ≥ 1 antiseizure medication (ASM) on/after initial diagnosis (first ASM=index), with ≥ 12 months' continuous medical/pharmacy benefits pre/post index, were analyzed from an all-payer claims database (01/01/2014-06/30/2021). Patients were clustered using machine learning/K-prototypes by variables (number of third-generation ASMs with formulary restrictions, brivaracetam [BRV] coverage status, race, ethnicity) selected to assess formulary impacts/health equity. Euclidean distance/simple matching was used for continuous/categorical data; elbow plots identified the optimal cluster number. Demographics/characteristics and 12-month follow-up healthcare resource utilization (HCRU)/costs were examined.
Five clusters were identified (N = 24,722): (1) mostly White, South region, easy access to third-generation ASMs (44.1%); (2) mostly Black, South region, easy access to third-generation ASMs (12.7%); (3) mostly White, North Central region, some third-generation ASM and high BRV access barriers (19.1%); (4) almost two-thirds Black, Northeast region, high third-generation ASM and some BRV access barriers (6.7%); (5) mostly White, North Central/Northeast region, high third-generation ASM and low BRV access barriers (17.3%). Clusters 1-2 were considered 'average' access barriers; 3-4 'high'; 5 'intermediate.' Clusters were generally similar in age/sex/ethnicity/ASM use. Over follow-up, cluster 3 had highest inpatient/outpatient HCRU and total costs. Prescription number/cost was highest in cluster 4, then cluster 3. Higher access restrictions patients generally had more prescriptions, outpatient/other visits, and higher costs.
Results suggest a relationship between formulary restrictions and economic burden, seemingly independent of age, sex, geographic region, and treatment utilization.

PMID:
42492130
Bibliographic data and abstract were imported from PubMed on 24 Jul 2026.

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