Sunday, August 16, 2015

Cost of newly diagnosed epilepsy

Ryan JL, McGrady ME, Guilfoyle SM, Junger K, Arnett AD, Modi AC. Health care
charges for youth with newly diagnosed epilepsy. Neurology. 2015 Aug



To estimate first-year health care charges for youth with newly diagnosed epilepsy seen within an interdisciplinary pediatric epilepsy team and examine demographic, clinical, and psychosocial predictors of annual charges.


Retrospective chart review was conducted to extract medical, hospital, and physician billing data from the year following an epilepsy diagnosis for 258 patients (aged 2-18 years) seen in a New Onset Seizure Clinic between July 2011 and December 2012. Descriptive statistics were used to estimate per-patient total first-year charges and health care utilization patterns (e.g., hospitalizations, emergency department visits, outpatient visits). Univariate analyses examined differences in health care charges between demographic, clinical, and psychosocial factors. Predictors of health care charges were examined using hierarchical multiple regression analysis.


The estimated per-patient total first-year health care charge was $20,084 (95% confidence interval [CI] $16,491-$23,677). Charges were higher for patients who reported having seizures since diagnosis ($25,509; 95% CI $20,162-$30,856) and were associated with more antiepileptic drug side effects (r = 0.18; 95% CI 0.03-0.32). Controlling for demographic and clinical factors, poorer baseline health-related quality of life was associated with higher per-patient health care charges (B = -445.40; 95% CI -865 to -25).


The economic impact of pediatric epilepsy in the year following diagnosis is substantial. Cost reduction efforts would be optimized by improving seizure control and targeting health-related quality of life, an outcome amenable to behavioral intervention.

from the text:  Baseline HRQOL was the strongest predictor of first-year health care charges after controlling for demographic and clinical factors. Although this relationship has not been examined previously in pediatric epilepsy, findings are consistent with pediatric and adult studies that demonstrate a direct impact of poor HRQOL on increased health care utilization. Poorer HRQOL predicted greater health care charges when charges related to behavioral medicine services were removed from the outcome variable, indicating that this relationship is not due to increased behavioral medicine service use. This suggests that establishing a behavioral medicine service to decrease impairment and optimize HRQOL, independent of other cost determinants, is not associated with higher health care charges. Future studies are needed to understand precisely how HRQOL affects health care utilization and costs.

Early work in cost containment focused predominantly on achieving seizure control. Our findings suggest that these efforts may be further enhanced by targeting HRQOL. Behavioral interventions targeting self-management, lifestyle, and exercise for children with asthma have successfully improved HRQOL and reduced health care utilization. Adapting these and similar interventions for youth with epilepsy is likely to be an integral component of low-cost, high-quality health care that needs to be further tested.


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