Objective:

To evaluate structural disparities in prescribing patterns, referral behavior, and workforce distribution in Saxony, a federal state with above-average epilepsy prevalence and treatment intensity.

Approach:

• Data Sources: Integrated IQVIA LRx® prescription data, Disease Analyzer prevalence estimates, and anonymized outpatient referral data from the DGfE-certified epilepsy center.
• Assessment Method: Utilization assessed using Days of Therapy (DOT), focusing on levetiracetam as a proxy for focal epilepsy care.
• Workforce Distribution: Estimated using Bundesärztekammer data.
• Expert Panel Contextualization: Findings contextualized through a multidisciplinary expert panel.

Key Findings:

• Approximately 36% of patients met a pharmacological proxy for drug resistance, but only a minority accessed specialized care.
• Prescribing patterns showed a preference for levetiracetam across all sectors, with regional variations in the levetiracetam to lamotrigine ratios.
• Adoption of newer antiseizure medications was concentrated in specialized hubs.
• Referral activity was uneven, with minimal connectivity to formal escalation pathways in several regions.

Interpretation:

Epilepsy care in Saxony is characterized by challenges in managing therapy-resistant patients, who often remain in decentralized care without systematic progression to specialized evaluation.

Limitations:

• The study may not capture all factors influencing referral practices and prescribing patterns.
• Regional variations may not be fully representative of broader trends across Germany.

Conclusion:

Identified gaps highlight the need for standardized referral criteria, strengthened cross-sectoral networks, and regional accountability mechanisms.