Yıl: 2022 Cilt: 28 Sayı: 1 Sayfa Aralığı: 45 - 50 Metin Dili: İngilizce DOI: 10.4274/tnd.2022.99233 İndeks Tarihi: 22-05-2023

Hospitalization Cost in Patients with Non-convulsive Status Epilepticus: Is it Different from Other Critical Care Patients?

Öz:
Objective: Status epilepticus (SE) is one of the severe neurological emergencies with significant morbidity and mortality. Most of the time these patients require admission to intensive care units. There is little information about health-economy related burden of SE and potential factors affecting cost except for developed Western countries, especially from the perspective of non-convulsive SE (NCSE). Materials and Methods: We included all consecutive patients diagnosed as having NCSE with continuous electroencephalogram (EEG) in our neurological intensive care unit (NICU) between 2009 and 2019. Demographic and clinical features were collected from patient files. Total cost during NICU care was obtained from hospital financial records. The results were compared with other NICU patients (control group) followed during the same period for the same length of stay. We also investigated the potential impact of several parameters on cost. Results: Thirty two patients with NCSE and 32 controls were included. Mean cost per patient was 11,831 US dollars (USD) in the study and 11,240 USD in the control group (p=0.386). Increased length of stay (p<0.001), lower Glasgow Coma scale score at admission (p=0.003), and new diagnosis of NCSE after admission to NICU (p=0.018) were significantly associated with higher cost in study group. SE related direct costs (anti-seizure medicines, anesthetics and continuous EEG) comprised only 3% of total NICU care expenditures. Conclusion: Management for NCSE in NICU leads to significant intensive care related cost. The similarity of the cost level to other NICU patients indicates that most of the expenditures are related to intensive care, rather than management of seizures. We found that a few patient-related parameters could significantly affect the cost, but they were all non-modifiable.
Anahtar Kelime:

Non-konvülsif Status Epileptikuslu Hastalarda Yatış Maliyeti: Diğer Yoğun Bakım Hastalarından Farklı mı?

Öz:
Amaç: Status epileptikus (SE), ciddi morbidite ve mortaliteye neden olan nörolojik acil durumlardan biridir. Çoğu zaman bu hastaların yoğun bakım ünitelerinde takibi gerekir. Özellikle non-konvülsif SE (NKSE) perspektifinden bakıldığında, SE’nin ekonomik yükü ve maliyeti etkileyen potansiyel faktörler hakkında çok az bilgi vardır. Gereç ve Yöntem: 2009-2019 yılları arasında nöroloji yoğun bakım ünitemizde (NYBÜ) video- elektroensefalogram (EEG) monitörizasyonu ile NKSE tanısı almış tüm hastaları dahil ettik. Demografik ve klinik özellikler hasta dosyalarından tarandı. NYBÜ bakımı sırasındaki toplam maliyet, hastanenin mali kayıtlarından elde edildi. Sonuçlar, aynı süre ve aynı kalış süresi boyunca takip edilen diğer NYBÜ hastaları (kontrol grubu) ile karşılaştırıldı. Maliyet üzerindeki potansiyel etkili olabilecek parametler gözden geçirildi. Bulgular: Otuz iki NKSE hastası ve 32 kontrol grubu hastası dahil edildi. Çalışmada hasta başına ortalama maliyet 11.831 Amerikan doları (USD), kontrol grubunda 11.240 USD idi (p=0,386). Artan yatış süresi (p<0,001), gelişte daha düşük Glasgow Koma skoru (p=0,003) ve NYBÜ takibi sırasında NKSE gelişmesi (p=0,018) maliyetle anlamlı olarak ilişkili bulundu. SE ile ilgili doğrudan maliyet (anti-epileptik ilaçlar, anestetikler ve video-EEG monitörizasyonu) toplam NYBÜ bakım harcamalarının yalnızca %3’ünü oluşturuyordu. Sonuç: NYBÜ’de NKSE yönetimi yüksek maliyete yol açmaktadır. Toplam maliyetin diğer NYBÜ hastalarına benzerliği, harcamaların çoğunun nöbet yönetiminden çok yoğun bakımla ilişkili olduğunu göstermektedir. Hastalarla ilişkili bazı parametrelerin maliyeti önemli ölçüde etkileyebileceği gösterilmiştir ancak bunlar değiştirilemez faktörlerdir.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Lv RJ, Wang Q, Cui T, Zhu F, Shao XQ. Status epilepticus-related etiology, incidence and mortality: a meta-analysis. Epilepsy Res 2017;136:12-17.
  • 2. Neligan A, Noyce AJ, Gosavi TD, et al. Change in mortality of generalized convulsive status epilepticus in high-income countries over time: a systematic review and meta-analysis. JAMA Neurol 2019;76:897-905.
  • 3. Kortland LM, Knake S, Rosenow F, Strzelczyk A. Cost of status epilepticus: a systematic review. Seizure 2015;24:17-20.
  • 4. Penberthy LT, Towne A, Garnett LK, Perlin JB, DeLorenzo RJ. Estimating the economic burden of status epilepticus to the health care system. Seizure 2005;14:46-51.
  • 5. Strzelczyk A, Knake S, Oertel WH, Rosenow F, Hamer HM. Inpatient treatment costs of status epilepticus in adults in Germany. Seizure 2013;22:882-885.
  • 6. Strzelczyk A, Nickolay T, Bauer S, et al. Evaluation of health-care utilization among adult patients with epilepsy in Germany. Epilepsy Behav 2012;23:451-457.
  • 7. Beg JM, Anderson TD, Francis K, et al. Burden of illness for super-refractory status epilepticus patients. J Med Econ 2017;20:45-53.
  • 8. Kortland LM, Alfter A, Bähr O, et al. Costs and cost-driving factors for acute treatment of adults with status epilepticus: A multicenter cohort study from Germany. Epilepsia 2016;57:2056-2066.
  • 9. Misra UK, Kalita J, Bhoi SK, Dubey D. Cost of status epilepticus in a tertiary care hospital in India. Seizure 2015;31:94-98.
  • 10. Mitchell RJ, Herkes G, Nikpour A, et al. Examining health service utilization, hospital treatment cost, and mortality of individuals with epilepsy and status epilepticus in New South Wales, Australia 2012-2016. Epilepsy Behav 2018;79:9-16.
  • 11. Sánchez Fernández I, Amengual-Gual M, Barcia Aguilar C, Loddenkemper T. Estimating the cost of status epilepticus admissions in the United States of America using ICD-10 codes. Seizure 2019;71:295-303.
  • 12. Sánchez Fernández I, Loddenkemper T. Estimating the cost of admissions related to convulsive status epilepticus in the United States of America. Seizure 2018;61:186-198.
  • 13. Santamarina E, Parejo B, Abraira L, et al. Cost of status epilepticus (SE): effects of delayed treatment and SE duration. Epilepsy Behav 2018;89:8-14.
  • 14. Strzelczyk A, Ansorge S, Hapfelmeier J, et al. Costs, length of stay, and mortality of super-refractory status epilepticus: a population-based study from Germany. Epilepsia 2017;58:1533-1541.
  • 15. Lu L, Xiong W, Yang X, et al. In-hospital mortality of status epilepticus in China: results from a nationwide survey. Seizure 2020;75:96-100.
  • 16. Leitinger M, Beniczky S, Rohracher A, et al. Salzburg consensus criteria for non-convulsive status epilepticus--approach to clinical application. Epilepsy Behav 2015;49:158-163.
  • 17. Holtkamp M, Othman J, Buchheim K, Meierkord H. Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J Neurol Neurosurg Psychiatry 2005;76:534-539.
  • 18. Shorvon S, Ferlisi M. The treatment of super-refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol. Brain 2011;134:2802-2818.
  • 19. Rossetti AO, Logroscino G, Milligan TA, et al. Status epilepticus severity score (STESS): a tool to orient early treatment strategy. J Neurol 2008;255:1561-1566.
  • 20. Reid AY, St Germaine-Smith C, Liu M, et al. Development and validation of a case definition for epilepsy for use with administrative health data. Epilepsy Res 2012;102:173-179.
  • 21. Ney JP, van der Goes DN, Nuwer MR, Nelson L, Eccher MA. Continuous and routine EEG in intensive care: utilization and outcomes, United States 2005-2009. Neurology 2013;81:2002-2008.
  • 22. Vespa PM, Nenov V, Nuwer MR. Continuous EEG monitoring in the intensive care unit: early findings and clinical efficacy. J Clin Neurophysiol 1999;16:1-13.
APA Ayvacioglu Cagan C, SOKMEN O, Arsava E, TOPCUOGLU M, Dericioglu N (2022). Hospitalization Cost in Patients with Non-convulsive Status Epilepticus: Is it Different from Other Critical Care Patients?. , 45 - 50. 10.4274/tnd.2022.99233
Chicago Ayvacioglu Cagan Cansu,SOKMEN OKAN,Arsava Ethem Murat,TOPCUOGLU MEHMET,Dericioglu Nese Hospitalization Cost in Patients with Non-convulsive Status Epilepticus: Is it Different from Other Critical Care Patients?. (2022): 45 - 50. 10.4274/tnd.2022.99233
MLA Ayvacioglu Cagan Cansu,SOKMEN OKAN,Arsava Ethem Murat,TOPCUOGLU MEHMET,Dericioglu Nese Hospitalization Cost in Patients with Non-convulsive Status Epilepticus: Is it Different from Other Critical Care Patients?. , 2022, ss.45 - 50. 10.4274/tnd.2022.99233
AMA Ayvacioglu Cagan C,SOKMEN O,Arsava E,TOPCUOGLU M,Dericioglu N Hospitalization Cost in Patients with Non-convulsive Status Epilepticus: Is it Different from Other Critical Care Patients?. . 2022; 45 - 50. 10.4274/tnd.2022.99233
Vancouver Ayvacioglu Cagan C,SOKMEN O,Arsava E,TOPCUOGLU M,Dericioglu N Hospitalization Cost in Patients with Non-convulsive Status Epilepticus: Is it Different from Other Critical Care Patients?. . 2022; 45 - 50. 10.4274/tnd.2022.99233
IEEE Ayvacioglu Cagan C,SOKMEN O,Arsava E,TOPCUOGLU M,Dericioglu N "Hospitalization Cost in Patients with Non-convulsive Status Epilepticus: Is it Different from Other Critical Care Patients?." , ss.45 - 50, 2022. 10.4274/tnd.2022.99233
ISNAD Ayvacioglu Cagan, Cansu vd. "Hospitalization Cost in Patients with Non-convulsive Status Epilepticus: Is it Different from Other Critical Care Patients?". (2022), 45-50. https://doi.org/10.4274/tnd.2022.99233
APA Ayvacioglu Cagan C, SOKMEN O, Arsava E, TOPCUOGLU M, Dericioglu N (2022). Hospitalization Cost in Patients with Non-convulsive Status Epilepticus: Is it Different from Other Critical Care Patients?. Türk Nöroloji Dergisi, 28(1), 45 - 50. 10.4274/tnd.2022.99233
Chicago Ayvacioglu Cagan Cansu,SOKMEN OKAN,Arsava Ethem Murat,TOPCUOGLU MEHMET,Dericioglu Nese Hospitalization Cost in Patients with Non-convulsive Status Epilepticus: Is it Different from Other Critical Care Patients?. Türk Nöroloji Dergisi 28, no.1 (2022): 45 - 50. 10.4274/tnd.2022.99233
MLA Ayvacioglu Cagan Cansu,SOKMEN OKAN,Arsava Ethem Murat,TOPCUOGLU MEHMET,Dericioglu Nese Hospitalization Cost in Patients with Non-convulsive Status Epilepticus: Is it Different from Other Critical Care Patients?. Türk Nöroloji Dergisi, vol.28, no.1, 2022, ss.45 - 50. 10.4274/tnd.2022.99233
AMA Ayvacioglu Cagan C,SOKMEN O,Arsava E,TOPCUOGLU M,Dericioglu N Hospitalization Cost in Patients with Non-convulsive Status Epilepticus: Is it Different from Other Critical Care Patients?. Türk Nöroloji Dergisi. 2022; 28(1): 45 - 50. 10.4274/tnd.2022.99233
Vancouver Ayvacioglu Cagan C,SOKMEN O,Arsava E,TOPCUOGLU M,Dericioglu N Hospitalization Cost in Patients with Non-convulsive Status Epilepticus: Is it Different from Other Critical Care Patients?. Türk Nöroloji Dergisi. 2022; 28(1): 45 - 50. 10.4274/tnd.2022.99233
IEEE Ayvacioglu Cagan C,SOKMEN O,Arsava E,TOPCUOGLU M,Dericioglu N "Hospitalization Cost in Patients with Non-convulsive Status Epilepticus: Is it Different from Other Critical Care Patients?." Türk Nöroloji Dergisi, 28, ss.45 - 50, 2022. 10.4274/tnd.2022.99233
ISNAD Ayvacioglu Cagan, Cansu vd. "Hospitalization Cost in Patients with Non-convulsive Status Epilepticus: Is it Different from Other Critical Care Patients?". Türk Nöroloji Dergisi 28/1 (2022), 45-50. https://doi.org/10.4274/tnd.2022.99233