Modular Program Report

Transcription

1 Modular Program Report The following report(s) provides findings from an FDA initiated query using its Mini Sentinel pilot. While Mini Sentinel queries may be undertaken to assess potential medical product safety risks, they may also be initiated for various other reasons. Some examples include determining a rate or count of an identified health outcome of interest, examining medical product use, exploring the feasibility of future, more detailed analyses within Mini Sentinel, and seeking to better understand the capabilities of the Mini Sentinel pilot. Data obtained through Mini Sentinel are intended to complement other types of evidence such as preclinical studies, clinical trials, postmarket studies, and adverse event reports, all of which are used by FDA to inform regulatory decisions regarding medical product safety. The information contained in this report is provided as part of FDA s commitment to place knowledge acquired from the Mini Sentinel pilot in the public domain as soon as possible. public health actions taken by FDA regarding products involved in Mini Sentinel queries will continue to be communicated through existing channels. FDA wants to emphasize that the fact that FDA has initiated a query involving a medical product and is reporting findings related to that query does not mean that FDA is suggesting health care practitioners should change their prescribing practices for the medical product or that patients taking the medical product should stop using it. Patients who have questions about the use of an identified medical product should contact their health care practitioners. The following report contains a description of the request, request specifications, and results from the modular program run(s). If you are using a web page screen reader and are unable to access this document, please contact the Mini Sentinel Operations Center for assistance at info@mini sentinel.org. 1

2 Overview Request Description FDA's Center for Drug Evaluation and Research requested execution of Modular Program #3 (MP3), version 5.0, to investigate kidney stones following new use of anti-epileptic medications among all exposed patients and among those with a pre-existing condition of epilepsy and those with an exclusion of pre-existing antidiabetic agent exposure. This involved two runs of MP3. This report contains the results from the second run-- kidney stones following new use of anti-epileptic medications among patients with a pre-existing condition of epilepsy or with an exclusion of pre-existing anti-diabetic agent use in the Mini-Sentinel Distributed Database (MSDD). A second report (MS_Brief_Report_MSY4_MPR55_v1, Report 1 of 2) contains results from the first run--kidney stones following new use of anti-epileptic medications among all exposed patients. Please see the Specifications tab for details into the exact parameters used in this request. The query was run against the Mini-Sentinel Distributed Database for the time period of January 1, 2004 December 31, The package was distributed to 18 Data Partners on August 15, Request ID msy4_mpr55_v1, Report 2 of 2 Specifications Glossary Program parameter inputs and scenarios List of terms found in this report and their definitions Table 1 Table 2 Table 3 Table 4 Appendix A Notes: Table displaying the Number of s, Episodes, Dispensings, Total, Years at Risk, Events, Eligible, Member-Years, s per 1,000 Eligible, per, Dispensings per, per Dispensing, and Events per 10,000 Years at Risk by Drug Product and Lookback Period - January 1, 2004 to December 31, 2012 Table displaying the Number of s, Episodes, Dispensings, Total, Years at Risk, Events, Eligible, Member-Years, s per 1,000 Eligible, per, Dispensings per, per Dispensing, and Events per 10,000 Years at Risk by Drug Product and Lookback Period and Age Group - January 1, 2004 to December 31, 2012 Table displaying the Number of s, Episodes, Dispensings, Total, Years at Risk, Events, Eligible, Member-Years, s per 1,000 Eligible, per, Dispensings per, per Dispensing, and Events per 10,000 Years at Risk by Drug Product and Lookback Period and Sex - January 1, 2004 to December 31, 2012 Table displaying the Number of s, Episodes, Dispensings, Total, Years at Risk, Events, Eligible, Member-Years, s per 1,000 Eligible, per, Dispensings per, per Dispensing, and Events per 10,000 Years at Risk by Drug Product and Lookback Period and Year - January 1, 2004 to December 31, 2012 Table displaying a list of epilepsy and kidney stone codes included in this request Please contact the Mini-Sentinel Operations Center (MSOC_Requests@harvardpilgrim.org) for questions and to provide comments/suggestions for future enhancements to this document MSY4_MPR55_V1, Report 2 of 2 2

3 Modular Program Specifications MSY4_MPR55_v1 Modular Program #3, version 5.0, was used to investigate kidney stones following new use of anti-epileptic drugs (AEDs) among all patients and among those with a pre-existing condition of epilepsy and those with an exclusion of pre-existing anti-diabetic agent use. The query period was from January 1, 2004-December 31, 2012, and the enrollment gap was set at 45 days. Age groups were split as follows: 0-9, 10-16, 17-64, 65+. In total, 31 different scenarios were examined in this request with differing exposures of interest, blackout periods, and inclusion/exclusion criteria. This report contains information from Scenarios 23 through 31 outlined below. A second report (msy4_mpr55_v1, Report 1 of 2) contains results from Scenarios 1 through 22. See below for a description of each of these scenarios. Enrollment Gap 45 Age Groups 0-9, 10-16, 17-64, 65+ Query Period January 1, December 31, 2012 Drug/Exposure Pre-Existing Condition Event/Outcome Scen ario Incident exposure Incident w/ respect to: Wash out (days) Inc idence Type* Episo de Gap Exposure Extension Period Min Episode Duration Min Pre- Existing Condition Include or Exclude Lookbac k Start Lookbac k End 1 Topiramate All AEDs 183 SING NA NA NA NA NA 2 Gabapentin All AEDs 183 SING NA NA NA NA NA 3 Zonisamide All AEDs 183 SING NA NA NA NA NA 4 Topiramate All AEDs 183 SING NA NA NA NA NA 5 Gabapentin All AEDs 183 SING NA NA NA NA NA 6 Zonisamide All AEDs 183 SING NA NA NA NA NA 7 Topiramate All AEDs 183 SING NA NA NA NA NA 8 Gabapentin All AEDs 183 SING NA NA NA NA NA 9 Zonisamide All AEDs 183 SING NA NA NA NA NA 10 Topiramate All AEDs 183 SING NA NA NA NA NA 11 Gabapentin All AEDs 183 SING NA NA NA NA NA 12 Zonisamide All AEDs 183 SING NA NA NA NA NA 13 Topiramate All AEDs 183 SING NA NA NA NA NA Care Settin g Event/ Outcome Care Setti ng Incident w/ respect to: Incident Only Care Setting Washou t (days) Incidence Type** Blacko ut Period 183 MULT MULT MULT MULT MULT MULT MULT MULT MULT MULT MULT MULT MULT 730 MSY4_MPR55_V1, Report 2 of 2 3

4 Drug/Exposure Pre-Existing Condition Event/Outcome Scen ario Incident exposure Incident w/ respect to: Wash out (days) Inc idence Type* Episo de Gap Exposure Extension Period Min Episode Duration Min Pre- Existing Condition Include or Exclude Lookbac k Start Lookbac k End 14 Gabapentin All AEDs 183 SING NA NA NA NA NA 15 Zonisamide All AEDs 183 SING NA NA NA NA NA 16 All AEDs All AEDs 183 SING NA NA NA NA NA 17 All AEDs minus topiramate, gabapentin, and zonisamide All AEDs 183 SING NA NA NA NA NA Care Settin g Event/ Outcome Care Setti ng Incident w/ respect to: Incident Only Care Setting Washou t (days) Incidence Type** Blacko ut Period 183 MULT MULT MULT MULT 0 18 Lamotrigine, levetiracetam, carbamazepine, oxcarbazepine, phenytoin, or valproic acid All AEDs 183 SING NA NA NA NA NA 183 MULT 0 19 Lamotrigine, levetiracetam, carbamazepine, oxcarbazepine, phenytoin, or valproic acid All AEDs 183 SING NA NA NA NA NA 183 MULT Lamotrigine, levetiracetam, carbamazepine, oxcarbazepine, phenytoin, or valproic acid All AEDs 183 SING NA NA NA NA NA 183 MULT Lamotrigine, levetiracetam, carbamazepine, oxcarbazepine, phenytoin, or valproic acid All AEDs 183 SING NA NA NA NA NA 183 MULT 365 MSY4_MPR55_V1, Report 2 of 2 4

5 Drug/Exposure Pre-Existing Condition Event/Outcome Scen ario 22 Incident exposure Lamotrigine, levetiracetam, carbamazepine, oxcarbazepine, phenytoin, or valproic acid Incident w/ respect to: Wash out (days) Inc idence Type* Episo de Gap Exposure Extension Period Min Episode Duration Min Pre- Existing Condition Include or Exclude Lookbac k Start Lookbac k End All AEDs 183 SING NA NA NA NA NA 23 Topiramate All AEDs 183 SING Epilepsy Include Gabapentin All AEDs 183 SING Epilepsy Include Zonisamide All AEDs 183 SING Epilepsy Include Topiramate All AEDs 183 SING Epilepsy Include Gabapentin All AEDs 183 SING Epilepsy Include Zonisamide All AEDs 183 SING Epilepsy Include Topiramate All AEDs 183 SING Gabapentin All AEDs 183 SING Zonisamide All AEDs 183 SING Care Settin g Anti- Diabetic Agent Exclude Anti- Diabetic Exclude Agent Anti- Diabetic Exclude Agent NDC codes checked against First Data Bank's "National Drug Data File (NDDF ) Plus" ICD-9-CM diagnosis and procedure codes checked against "Ingenix 2012 ICD-9-CM Data File" provided by OptumInsight HCPCS codes checked against "Optum 2012 HCPCS Level II Data File" provided by OptumInsight CPT codes checked against "Optum 2012 Current Procedure Codes & Relative Values Data File" provided by OptumInsight Event/ Outcome Care Setti ng Incident w/ respect to: Incident Only Care Setting Washou t (days) Incidence Type** Blacko ut Period 183 MULT MULT MULT MULT MULT MULT MULT MULT MULT MULT 0 *Single incidence type for the exposure will only consider the first incident episode for each user during the query period that satisfies the Washout Period criteria (183 or 365 days). There can be at most one episode per user. **Mult incidence type for the event will only consider the first event for each episode that satisfies the Washout Period criteria of 183 days. There can be at most one event per episode and consequently, one event per user. MSY4_MPR55_V1, Report 2 of 2 5

6 Glossary of Terms in Modular Program 3* Blackout Period - number of days at the beginning of a treatment episode that events are to be ignored. If an event occurs during the blackout period, the episode is excluded. Care Setting - type of medical encounter or facility where the exposure, event, or condition code was recorded. Possible care settings include: Inpatient Hospital Stay (IP), Non-Acute Institutional Stay (IS), Emergency Department (ED), Ambulatory Visit (AV), and Other Ambulatory Visit (OA). at Risk - number of days supplied plus any episode gaps and exposure extension periods. Eligible - Number of members eligible for an incident treatment episode (defined by the drug/exposure and event washout periods) with drug and medical coverage during the query period. Enrollment Gap - number of days allowed between two consecutive enrollment periods without breaking a continuously enrolled sequence. Episode Gap - number of days allowed between two (or more) consecutive exposures (dispensings/procedures) to be considered the same treatment episode. Exposure Extension Period - number of days post treatment period in which the outcomes/events are counted for a treatment episode. Incidence Type (drug/exposure)- Minimum incidence type will consider the first treatment episode in the query period as long as it is the first treatment episode in the user's entire available history. Single and Multiple incidnece types will use the washout period to establish incidence, however Single will only consider the first treatment episode whereas Multiple will consider all qualifying incident treatment episodes. Incidence Type (event/outcome)- Minimum incidence type considers the first event in a valid episode as long as it is the first event in the user's entire available history. Multiple incidence type uses the washout period to establish incidence and considers all qualifying incident treatment episodes. The program will only consider one event per episode, but the Multiple incidence type will consider more than one event per user if a user has more than one incident episode. Lookback Period (pre-existing condition) - number of days wherein a member is required to have evidence of pre-existing condition (diagnosis/procedure/drug dispensing). Member- - sum of all days of enrollment with medical and drug coverage** in the query period preceded by an exposure washout period. Minimum - specifies a minimum number of days in length of the days supplied for the episode to be considered. Minimum Episode Duration - specifies a minimum number of days in length of the epsiode for it to be considered. Episodes - new treatment episodes; length of episode is determined by days supplied in one dispensing (or consecutive dispensings bridged by the episode gap. s - number of members with incident exposure during the query period. Member must have no evidence of exposure (s) of interest (defined by incidence criteria) in the prior washout period. A user may only be counted once in a query period. Principal Diagnosis - diagnosis or condition established to be chiefly responsible for admission of the patient to the hospital. YES will only consider diagnoses flagged as Principal. Query Period - period in which the modular program looks for exposures and outcomes of interest. Total - number of days supplied for all dispensings in qualifying treatment episodes. Washout Period (drug/exposure)** - number of days a user is required to have no evidence of prior exposure (drug dispensing/procedure) and continuous drug and medical coverage prior to an incident treatment episode. Washout Period (event/outcome)** - number of days a user is required to have no evidence of a prior event (procedure/diagnosis) and continuous drug and medical coverage prior to an incident treatment episode. *all terms may not be used in this report **incident treatment episodes must be incident to both the exposure and the event MSY4_MPR55_V1, Report 2 of 2 6

7 Table 1: Summary of Incident Anti-Epileptic Drug Use and in the MSDD between January 1, 2004 and December 31, 2012, by Drug Product, Pre-Existing Condition Criteria, and Lookback Period s / 1K Eligible Dispensing s Episodes Dispensings Total Years at Risk Events Eligible Member-Years Dispensings / Events / 10K Years at Risk Gabapentin (Pre-Existing Condition of Epilepsy, 183-Day Lookback Period) 5,341 5,341 13, ,152 1, , , Gabapentin (Pre-Existing Condition of Epilepsy, 365-Day Lookback Period) 7,834 7,834 19, ,800 1, , , Gabapentin (Exclusion of Individuals with Pre-Existing Anti-Diabetic Agent Use, 183-Day Lookback) 1,087,633 1,087,633 2,303,021 79,851, ,817 5,781 84,182, ,626, Topiramate (Pre-Existing Condition of Epilepsy, 183-Day Lookback Period) 6,769 6,769 21, ,929 2, , , Topiramate (Pre-Existing Condition of Epilepsy, 365-Day Lookback Period) 8,209 8,209 25, ,957 2, , , Topiramate (Exclusion of Individuals with Pre-Existing Anti-Diabetic Agent Use, 183-Day Lookback) 332, , ,382 28,368,852 83,507 1,999 84,182, ,291, Zonisamide (Pre-Existing Condition of Epilepsy, 183-Day Lookback Period) 1,556 1,556 6, , , , Zonisamide (Pre-Existing Condition of Epilepsy, 365-Day Lookback Period) 1,820 1,820 6, , , , Zonisamide (Exclusion of Individuals with Pre-Existing Anti-Diabetic Agent Use, 183-Day Lookback) 16,710 16,710 42,825 1,386,937 4, ,182, ,525, MSY4_MPR55_V1, Report 2 of 2 7

8 Table 2: Summary of Incident Anti-Epileptic Drug Use and in the MSDD between January 1, 2004 and December 31, 2012, by Drug Product, Pre-Existing Condition Criteria, Lookback Period, and Age Group s / 1K Eligible Dispensing s Episodes Dispensings Total Years at Risk Events Eligible Member-Years Dispensings / Events / 10K Years at Risk Gabapentin (Pre-Existing Condition of Epilepsy, 183-Day Lookback Period) 0 to 9 Years , ,388 24, to 16 Years , ,359 19, to 64 Years 3,819 3,819 9, , , , Years 1,268 1,268 3, , ,744 32, Gabapentin (Pre-Existing Condition of Epilepsy, 365-Day Lookback Period) 0 to 9 Years , ,944 40, to 16 Years , ,105 31, to 64 Years 5,597 5,597 13, ,951 1, , , Years 1,909 1,909 5, , ,449 50, Gabapentin (Exclusion of Individuals with Pre-Existing Anti-Diabetic Agent Use, 183-Day Lookback) 0 to 9 Years 2,616 2,616 6, , ,525,023 24,497, to 16 Years 10,534 10,534 21, ,383 2, ,527,423 19,945, to 64 Years 797, ,173 1,601,977 52,924, ,453 3,857 60,813, ,467, Years 277, , ,820 26,051,882 75,703 1,907 6,949,176 17,715, Topiramate (Pre-Existing Condition of Epilepsy, 183-Day Lookback Period) 0 to 9 Years ,863 93, ,388 24, to 16 Years , , ,319 19, to 64 Years 4,877 4,877 14, ,342 1, , , Years , ,756 32, Topiramate (Pre-Existing Condition of Epilepsy, 365-Day Lookback Period) 0 to 9 Years , , ,944 40, to 16 Years 1,115 1,115 4, , ,033 31, to 64 Years 6,042 6,042 16, ,627 1, , , Years ,015 39, ,471 50, Topiramate (Exclusion of Individuals with Pre-Existing Anti-Diabetic Agent Use, 183-Day Lookback) 0 to 9 Years 4,223 4,223 12, ,287 1, ,525,023 24,497, to 16 Years 24,726 24,726 58,274 1,889,065 5, ,526,699 19,938, to 64 Years 294, , ,102 25,149,968 73,934 1,896 60,809, ,885, Years 9,502 9,502 23, ,532 2, ,969,167 17,970, MSY4_MPR55_V1, Report 2 of 2 8

9 Table 2: Summary of Incident Anti-Epileptic Drug Use and in the MSDD between January 1, 2004 and December 31, 2012, by Drug Product, Pre-Existing Condition Criteria, Lookback Period, and Age Group s Episodes Dispensings Total Zonisamide (Pre-Existing Condition of Epilepsy, 183-Day Lookback Period) Years at Risk Events Eligible Member-Years s / 1K Eligible Dispensings / Dispensing Events / 10K Years at Risk 0 to 9 Years ,212 37, ,388 24, to 16 Years ,188 39, ,355 19, to 64 Years , , , , Years , ,763 32, Zonisamide (Pre-Existing Condition of Epilepsy, 365-Day Lookback Period) 0 to 9 Years ,298 40, ,944 40, to 16 Years ,252 41, ,099 31, to 64 Years 1,185 1,185 3, , , , Years , ,487 50, Zonisamide (Exclusion of Individuals with Pre-Existing Anti-Diabetic Agent Use, 183-Day Lookback) 0 to 9 Years ,602 85, ,525,023 24,499, to 16 Years 1,181 1,181 4, , ,528,184 19,952, to 64 Years 14,147 14,147 33,476 1,076,344 3, ,817, ,094, Years ,627 91, ,970,962 17,979, MSY4_MPR55_V1, Report 2 of 2 9

10 Table 3: Summary of Incident Anti-Epileptic Drug Use and in the MSDD between January 1, 2004 and December 31, 2012, by Drug Product, Pre-Existing Condition Criteria, Lookback Period, and Sex s / 1K Eligible Dispensing s Episodes Dispensings Total Years at Risk Events Eligible Member-Years Dispensings / Events / 10K Years at Risk Gabapentin (Pre-Existing Condition of Epilepsy, 183-Day Lookback Period) Female 3,145 3,145 8, , ,374 88, Male 2,196 2,196 5, , ,217 88, Unknown Gabapentin (Pre-Existing Condition of Epilepsy, 365-Day Lookback Period) Female 4,727 4,727 11, ,098 1, , , Male 3,107 3,107 7, , , , Unknown Gabapentin (Exclusion of Individuals with Pre-Existing Anti-Diabetic Agent Use, 183-Day Lookback) Female 663, ,672 1,398,058 48,645, ,004 2,857 42,705,797 96,142, Male 423, , ,898 31,202,607 92,805 2,924 41,472,742 92,477, Unknown , ,833 6, Topiramate (Pre-Existing Condition of Epilepsy, 183-Day Lookback Period) Female 4,824 4,824 14, ,470 1, ,373 88, Male 1,944 1,944 6, , ,218 88, Unknown Topiramate (Pre-Existing Condition of Epilepsy, 365-Day Lookback Period) Female 5,908 5,908 17, ,486 1, , , Male 2,300 2,300 7, , , , Unknown Topiramate (Exclusion of Individuals with Pre-Existing Anti-Diabetic Agent Use, 183-Day Lookback) Female 271, , ,350 23,637,783 69,501 1,515 42,705,794 96,505, Male 61,778 61, ,013 4,730,515 14, ,472,756 92,779, Unknown ,833 6, Zonisamide (Pre-Existing Condition of Epilepsy, 183-Day Lookback Period) Female , , ,374 88, Male ,806 93, ,217 88, Unknown MSY4_MPR55_V1, Report 2 of 2 10

11 Table 3: Summary of Incident Anti-Epileptic Drug Use and in the MSDD between January 1, 2004 and December 31, 2012, by Drug Product, Pre-Existing Condition Criteria, Lookback Period, and Sex s Episodes Dispensings Total Zonisamide (Pre-Existing Condition of Epilepsy, 365-Day Lookback Period) Years at Risk Events Eligible Member-Years s / 1K Eligible Dispensings / Dispensing Events / 10K Years at Risk Female 1,042 1,042 3, , , , Male , , , , Unknown Zonisamide (Exclusion of Individuals with Pre-Existing Anti-Diabetic Agent Use, 183-Day Lookback) Female 12,364 12,364 30, ,844 2, ,705,832 96,692, Male 4,345 4,345 12, ,063 1, ,472,757 92,826, Unknown ,833 6, MSY4_MPR55_V1, Report 2 of 2 11

12 Table 4: Summary of Incident Anti-Epileptic Drug Use and in the MSDD between January 1, 2004 and December 31, 2012, by Drug Product, Pre-Existing Condition Criteria, Lookback Period, and Year s Episodes Dispensings Total Gabapentin (Pre-Existing Condition of Epilepsy, 183-Day Lookback Period) Years at Risk Events Eligible Member-Years s / 1K Eligible Dispensings / Dispensing Events / 10K Years at Risk , ,737 3, , ,461 3, , ,363 7, , ,421 12, ,970 69, ,926 23, ,397 82, ,559 31, ,639 89, ,773 32, ,023 1,023 2,539 86, ,631 32, ,119 1,119 2,147 70, ,599 28, Gabapentin (Pre-Existing Condition of Epilepsy, 365-Day Lookback Period) , ,448 6, , ,305 6, , ,003 11, ,254 42, ,454 21, ,609 90, ,771 37, ,307 1,307 3, , ,059 52, ,452 1,452 3, , ,216 53, ,570 1,570 3, , ,257 53, ,636 1,636 3, , ,628 47, Gabapentin (Exclusion of Individuals with Pre-Existing Anti-Diabetic Agent Use, 183-Day Lookback) ,389 29,389 78,275 2,827,023 8, ,003,790 6,343, ,058 26,058 62,022 2,532,175 7, ,209,334 6,661, ,329 45, ,233 4,287,203 12, ,685,842 11,206, ,555 74, ,066 6,483,149 19, ,099,241 15,878, , , ,285 10,504,830 31, ,097,888 25,954, , , ,816 14,063,881 42, ,835,105 33,279, , , ,005 14,222,330 42,702 1,095 41,894,139 31,944, , , ,505 14,128,514 42,463 1,185 40,575,396 31,205, , , ,814 10,802,051 31, ,502,989 26,151, MSY4_MPR55_V1, Report 2 of 2 12

13 Table 4: Summary of Incident Anti-Epileptic Drug Use and in the MSDD between January 1, 2004 and December 31, 2012, by Drug Product, Pre-Existing Condition Criteria, Lookback Period, and Year s Episodes Dispensings Total Topiramate (Pre-Existing Condition of Epilepsy, 183-Day Lookback Period) Years at Risk Events Eligible Member-Years s / 1K Eligible Dispensings / Dispensing Events / 10K Years at Risk , ,737 3, , ,449 3, ,316 45, ,349 7, ,308 77, ,400 12, ,030 1,030 3, , ,876 23, ,292 1,292 4, , ,481 31, ,137 1,137 3, , ,651 32, ,095 1,095 3, , ,519 32, ,859 62, ,473 28, Topiramate (Pre-Existing Condition of Epilepsy, 365-Day Lookback Period) , ,448 6, , ,290 6, ,508 52, ,978 11, ,623 90, ,376 21, ,185 1,185 4, , ,684 37, ,575 1,575 4, , ,948 52, ,405 1,405 4, , ,004 53, ,341 1,341 3, , ,143 53, ,227 1,227 2,303 77, ,497 47, Topiramate (Exclusion of Individuals with Pre-Existing Anti-Diabetic Agent Use, 183-Day Lookback) ,678 8,678 25, ,031 2, ,003,789 6,344, ,584 7,584 20, ,454 2, ,221,684 6,668, ,154 16,154 49,116 1,872,039 5, ,705,428 11,219, ,468 25,468 76,664 2,756,509 8, ,135,318 15,904, ,901 43, ,379 3,983,060 11, ,162,966 26,002, ,210 61, ,587 5,437,373 16, ,950,139 33,364, ,339 59, ,096 5,058,627 14, ,068,851 32,075, ,291 56, ,590 4,365,991 12, ,804,039 31,379, ,216 54,216 97,562 3,175,768 9, ,770,154 26,332, MSY4_MPR55_V1, Report 2 of 2 13

14 Table 4: Summary of Incident Anti-Epileptic Drug Use and in the MSDD between January 1, 2004 and December 31, 2012, by Drug Product, Pre-Existing Condition Criteria, Lookback Period, and Year s Episodes Dispensings Total Zonisamide (Pre-Existing Condition of Epilepsy, 183-Day Lookback Period) Years at Risk Events Eligible Member-Years s / 1K Eligible Dispensings / Dispensing , ,737 3, , ,464 3, , ,362 7, Events / 10K Years at Risk , ,439 13, , ,963 23, ,150 39, ,642 31, ,169 38, ,897 32, , ,783 32, , ,800 28, Zonisamide (Pre-Existing Condition of Epilepsy, 365-Day Lookback Period) , ,448 6, , ,329 6, , ,036 11, , ,500 21, ,095 34, ,880 37, ,346 45, ,301 52, ,248 41, ,554 53, , ,737 54, , ,123 47, Zonisamide (Exclusion of Individuals with Pre-Existing Anti-Diabetic Agent Use, 183-Day Lookback) ,894 87, ,003,790 6,344, ,358 44, ,225,962 6,671, ,953 98, ,713,152 11,224, ,404 1,404 4, , ,149,926 15,914, ,340 2,340 6, , ,189,204 26,020, ,083 3,083 7, , ,994,663 33,394, ,772 2,772 7, , ,136,377 32,121, ,493 2,493 6, , ,890,306 31,440, ,176 2,176 4, , ,865,844 26,394, MSY4_MPR55_V1, Report 2 of 2 14

15 Appendix A. List of Codes included in this Request Epilepsy Code: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Diagnosis Code 345* Epilepsy Stone Codes: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Diagnosis Codes Calculus of kidney Calculus of ureter Urinary calculus, unspecified Uric acid nephrolithiasis 594 Calculus of lower urinary tract International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Procedure Codes Percutaneous Nephrostomy With Fragmentation Percutaneous aspiration of kidney (pelvis) 56.2 Ureterotomy 59.8 Ureteral Catheterization Ultrasonic Fragmentation Of Urinary Extracorporeal shockwave lithotripsy of the kidney, ureter and/or bladder Percutaneous Nephrostomy With Fragmentation Extracorporeal shockwave lithotripsy of the kidney, ureter and/or bladder Ultrasonic Fragmentation Of Urinary Healthcare Common Procedure Coding System (HCPCS) Removal of Stone Incision of Incision of Removal of Stone Removal of Stone Removal of Stone Removal of Stone Fragmenting of Stone Removal of Ureter Stone Removal of Ureter Stone Removal of Ureter Stone Cystoscopy and Treatment Cystoscopy Stone Removal Cystoscopy and Treatment Cystourethroscopy with Ureteroscopy; with Remove Calculus Cystourethroscopy with Ureteroscopy; with Lith Laparoscopy Ureterolithotomy Endoscopy and Treatment Endoscopy and Treatment Removal of Ureter Stone Remove Ureter Calculus Removal of Stone Removal of Stone Removal of Stone Incision of Removal of Stone Removal of Ureter Stone Removal of Ureter Stone MSY4_MPR55_V1, Report 2 of 2 15

16 Healthcare Common Procedure Coding System (HCPCS) - continued Removal of Ureter Stone Fragmenting of Stone Cystoscopy and Treatment Cystoscopy Stone Removal Cystouretero with Stone Remove Cystouretero with Lithotripsy MSY4_MPR55_V1, Report 2 of 2 16