Evaluating Treatment Patterns in Bell's Palsy Using Nationwide Employer-Sponsored Healthcare Claims

Abstract

Objective: Professional society guidelines provide clear recommendations regarding the use of high-dose steroids and/or antiviral therapy for Bell's palsy patients. This study evaluates national trends in the care of Bell's palsy patients and identifies current treatments. Methods: A retrospective cohort study of adult Bell's palsy patients was conducted using ICD-9-CM and ICD-10-CM diagnosis codes from 2013 to 2020. These patients were continuously enrolled in the employer-sponsored MarketScan commercial or Medicare outpatient and prescription drug claims data for at least 1 year. The main outcome of interest was prescription rates of high-dose steroids and antivirals after the diagnosis date. Results: In this cohort of 66,708 adult Bell's palsy patients, 29,824 (44.7%) received no treatment. 22,736 (34.1%) received combination therapy, 11,866 (17.8%) received steroids only, and 2282 (3.4%) received antivirals only. Males were more likely to receive combination therapy. 51.9% of Bell's palsy patients in this cohort received the AAO-recommended treatment of steroids within 72 h of diagnosis. Patients in the Southern and Western United States were more commonly prescribed combination therapy. Comorbidities such as cerebrovascular disease and symptoms like ear pain were associated with a higher likelihood of receiving combination therapy. Treatment initiation, particularly for steroids, occurred on the index date, first insurance claim, in 94.56% of cases. Conclusion: Only 51.9% of Bell's palsy patients in this cohort received the AAO-recommended treatment with high-dose steroids with or without antiviral therapy. This research provides valuable insights into the real-world management of Bell's palsy, emphasizing the need for adherence to established treatment guidelines. Level of Evidence: N/A.