The Health Care Burden of Patients With Epilepsy in the US
The Health Care Burden of Patients With Epilepsy in the US
Object. The aim of this study was to analyze the national health care burden of patients diagnosed with epilepsy in the US and to analyze any changes in the length of stay, mean charges, in-hospital deaths (mortality), and disposition at discharge.
Methods. A retrospective review of the Nationwide Inpatient Sample (NIS) database for epilepsy admissions was completed for the years from 1993 to 2008. The NIS is maintained by the Agency for Healthcare Research and Quality and represents a 20% random stratified sample of all discharges from nonfederal hospitals within the US. Patients with epilepsy were identified using ICD-9 codes beginning with 345.XX. Approximately 1.1 million hospital admissions were identified over a span of 15 years.
Results. Over this 15-year period (between 1993 and 2008), the average hospital charge per admission for patients with epilepsy has increased significantly (p < 0.001) from $10,050 to $23,909, an increase of 137.9%. This is in spite of a 33% decrease in average length of stay from 5.9 days to 3.9 days. There has been a decrease in the percentage of in-hospital deaths by 57.9% and an increase in discharge to outside medical institutions.
Conclusions. The total national charges associated with epilepsy in 2008 were in excess of $2.7 billion (US dollars, normalized). During the studied period, the cost per day for patients rose from $1703.39 to $6130.51. In spite of this drastic increase in health care cost to the patient, medical and surgical treatment for epilepsy has not changed significantly, and epilepsy remains a major source of morbidity.
It has been estimated that approximately 1% of the US population suffers from epilepsy. Epilepsy is a unique disease to analyze from an economic standpoint. The high prevalence, high morbidity, and low mortality of this disease combine to create a disproportionately high cost of illness compared with other diseases. Analysis of the disease is made difficult by the heterogeneous patient population; although 80% of patients diagnosed with epilepsy will achieve effective remission of the disease after approximately 5 years, a sizeable portion of patients will suffer from medically intractable epilepsy. Recent years have seen different avenues of treatment emerge for such patients, such as new surgical techniques and VNS. New developments in therapy for epilepsy coupled with advances in diagnostic technology have led to an increase in interventions. In spite of this, epilepsy remains a prevalent problem in the acute care setting worldwide.
Several international studies have addressed the epidemiology of health care in epilepsy; however, there are a limited number of papers that have addressed the socioeconomic changes in the care provided in the US. In their review article, Strzelczyk et al., analyzed the cost of the illness of epilepsy, including indirect expenses to patients with epilepsy, by evaluating 22 studies worldwide. These authors also emphasized the need for studies that evaluate the impact that new antiepileptic treatments have had on the current cost of illness in epilepsy in the US. To our knowledge, there are no current studies that have analyzed trends in admissions, cost, and disposition of epilepsy in the US.
This retrospective study aims to analyze trends related to epilepsy in a nationwide database and to examine the health care burden of this disease. This analysis focuses on changes in LOS, mean hospital charge, in-hospital deaths, and disposition of the epileptic patient after hospitalization. By evaluating the data of more than 1.1 million patients admitted to the hospital for epilepsy in the US, we aim to bypass several limitations of international and private studies that include differing standards of care in practice, varying study populations, and heterogeneous economic climates that currently exist worldwide.
Abstract and Introduction
Abstract
Object. The aim of this study was to analyze the national health care burden of patients diagnosed with epilepsy in the US and to analyze any changes in the length of stay, mean charges, in-hospital deaths (mortality), and disposition at discharge.
Methods. A retrospective review of the Nationwide Inpatient Sample (NIS) database for epilepsy admissions was completed for the years from 1993 to 2008. The NIS is maintained by the Agency for Healthcare Research and Quality and represents a 20% random stratified sample of all discharges from nonfederal hospitals within the US. Patients with epilepsy were identified using ICD-9 codes beginning with 345.XX. Approximately 1.1 million hospital admissions were identified over a span of 15 years.
Results. Over this 15-year period (between 1993 and 2008), the average hospital charge per admission for patients with epilepsy has increased significantly (p < 0.001) from $10,050 to $23,909, an increase of 137.9%. This is in spite of a 33% decrease in average length of stay from 5.9 days to 3.9 days. There has been a decrease in the percentage of in-hospital deaths by 57.9% and an increase in discharge to outside medical institutions.
Conclusions. The total national charges associated with epilepsy in 2008 were in excess of $2.7 billion (US dollars, normalized). During the studied period, the cost per day for patients rose from $1703.39 to $6130.51. In spite of this drastic increase in health care cost to the patient, medical and surgical treatment for epilepsy has not changed significantly, and epilepsy remains a major source of morbidity.
Introduction
It has been estimated that approximately 1% of the US population suffers from epilepsy. Epilepsy is a unique disease to analyze from an economic standpoint. The high prevalence, high morbidity, and low mortality of this disease combine to create a disproportionately high cost of illness compared with other diseases. Analysis of the disease is made difficult by the heterogeneous patient population; although 80% of patients diagnosed with epilepsy will achieve effective remission of the disease after approximately 5 years, a sizeable portion of patients will suffer from medically intractable epilepsy. Recent years have seen different avenues of treatment emerge for such patients, such as new surgical techniques and VNS. New developments in therapy for epilepsy coupled with advances in diagnostic technology have led to an increase in interventions. In spite of this, epilepsy remains a prevalent problem in the acute care setting worldwide.
Several international studies have addressed the epidemiology of health care in epilepsy; however, there are a limited number of papers that have addressed the socioeconomic changes in the care provided in the US. In their review article, Strzelczyk et al., analyzed the cost of the illness of epilepsy, including indirect expenses to patients with epilepsy, by evaluating 22 studies worldwide. These authors also emphasized the need for studies that evaluate the impact that new antiepileptic treatments have had on the current cost of illness in epilepsy in the US. To our knowledge, there are no current studies that have analyzed trends in admissions, cost, and disposition of epilepsy in the US.
This retrospective study aims to analyze trends related to epilepsy in a nationwide database and to examine the health care burden of this disease. This analysis focuses on changes in LOS, mean hospital charge, in-hospital deaths, and disposition of the epileptic patient after hospitalization. By evaluating the data of more than 1.1 million patients admitted to the hospital for epilepsy in the US, we aim to bypass several limitations of international and private studies that include differing standards of care in practice, varying study populations, and heterogeneous economic climates that currently exist worldwide.
Source...