The health care burden of patients with epilepsy in the United States: An analysis of a nationwide database over 15 years

Department of Neurological Surgery and Brain Repair, University of South Florida, Tampa, Florida, USA.
Neurosurgical FOCUS (Impact Factor: 2.11). 03/2012; 32(3):E1. DOI: 10.3171/2012.1.FOCUS11322
Source: PubMed


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.
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 U.S. 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.
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.
The total national charges associated with epilepsy in 2008 were in excess of $2.7 billion (U.S. 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.

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    • "Approximately 50 million people worldwide are affected by epilepsy [1] and it represents the second neurological disorder in incidence and prevalence after cerebrovascular disease [2]. It has a significant psychological and social impact on patients and relatives, and its high morbidity and low mortality create increasing and disproportionately high costs of illness compared with other diseases [3] [4]. Most of the patients are successfully controlled with antiepileptic drugs (AEDs); however, treatment-resistant epilepsy (TRE) has been reported to occur in 20–30% of patients [1,5–7] and only 20–40% of them meet criteria for surgical treatment [8]. "
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    ABSTRACT: Treatment-resistant epilepsy (TRE) occurs in 20-30% of patients. The goal of this study is to assess the efficacy and safety of vagus nerve stimulation (VNS) in this group of patients, including adult and pediatric populations and several off-label indications. This is a retrospective review of 59 consecutive patients in whom 60 VNS devices were implanted at a single institution during a 15-year period. Patients were evaluated in the Multidisciplinary Epilepsy Committee and complete presurgical workup was performed. The series included indications not approved by the FDA, such as children under 12 years of age, pregnancy and right-sided VNS. Performing the procedure on an out-patient basis was recently adopted, minimizing hospital length of stay. There were 42 adults and 17 children (14 under 12 years of age) and the mean age at implantation was 26 years. Duration of VNS therapy ranged from 6 months to 9 years. For the entire cohort, the mean percentage seizure reduction was 31.37%. Twenty patients (34.48%) were considered responders (seizure reduction ≥50%); 7 patients (12.06%) had seizure reduction of ≥75% and 2 patients had seizure control of ≥90% (3.4%). The patient in whom right-sided VNS was implanted achieved the same reduction in seizure burden and the patient who became pregnant could reduce antiepileptic drugs dosage, without complications. Side-effects were mild and there were no permanent nerve injuries. One patient died in the follow-up due to psychiatric disorders previously known. VNS is a safe and effective palliative treatment for TRE patients. There are an increasing number of indications and further randomized trials would potentially expand the number of patients who may benefit from it. A multidisciplinary team is crucial for a complete preoperative evaluation and selection of the optimal candidates for the treatment. Copyright © 2015 Elsevier B.V. All rights reserved.
    Clinical neurology and neurosurgery 07/2015; 137:89-93. DOI:10.1016/j.clineuro.2015.06.023 · 1.13 Impact Factor
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    • "Epilepsy is one of the most common neurological disorders. Epidemiological studies found a prevalence of 0.5 to 1 % of the European and North American population, and economic costs are high (MacDonald et al. 2000; Pachlatko 2008; Vivas et al. 2012). About 60 % of epilepsy cases are classified as focal epilepsies (Loiseau et al. 1990). "
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