Medical health care utilization cost of patients presenting with psychogenic nonepileptic seizures

Udaya Seneviratne, Zhi Mei Low, Zhi Xuen Low, Angela Hehir, Sahira Paramaswaran, Monica Foong, Henry Ma, Thanh G. Phan

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: To investigate the health care utilization cost of patients presenting with psychogenic nonepileptic seizures (PNES) to a tertiary hospital in Australia. Methods: This is a retrospective analysis of adult patients with PNES based on video-electroencephalographic confirmation over a 5-year period. We used an itemized list to collect detailed health care utilization data. The items included emergency room visits, hospital ward admissions, intensive care unit (ICU) admissions, outpatient neurology clinic visits, medical interventions, Code Blue and Medical Emergency Team calls for seizures, medications, and investigations. We calculated the cost of each individual item separately for each individual presentation. To investigate the proportional contribution of each covariate toward the total health care utilization cost, an analysis of the relative importance in the linear regression was performed. Results: There were 39 patients, of whom seven (18%) were admitted to the ICU with suspected status epilepticus. The median total health care utilization cost per person until the diagnosis of PNES was established as 26 468 Australian dollars (AUD; 19 207 US dollars [USD]). In the item breakdown, the highest median cost was incurred by investigations (13 119 AUD = 9520 USD), followed by hospital ward management (8890 AUD = 6451 USD), ICU stay (3764 AUD = 2731 USD), outpatient neurology clinics (2200 AUD = 1596 USD), and emergency room visits (570 AUD = 413 USD). Nonepileptic psychogenic status (23%) and the duration of PNES disorder (10%) were the most significant variables contributing to the variance (R2) of the model. Significance: A considerable burden of health care utilization cost is caused by PNES. The presence of nonepileptic psychogenic status and a longer duration of the condition predict a higher cost.

Original languageEnglish
Pages (from-to)349-357
Number of pages9
JournalEpilepsia
Volume60
Issue number2
DOIs
Publication statusPublished - 1 Feb 2019

Keywords

  • cost-effectiveness
  • epilepsy monitoring
  • medical care
  • psychogenic nonepileptic seizures
  • status epilepticus

Cite this

Seneviratne, Udaya ; Low, Zhi Mei ; Low, Zhi Xuen ; Hehir, Angela ; Paramaswaran, Sahira ; Foong, Monica ; Ma, Henry ; Phan, Thanh G. / Medical health care utilization cost of patients presenting with psychogenic nonepileptic seizures. In: Epilepsia. 2019 ; Vol. 60, No. 2. pp. 349-357.
@article{e93379a6ad744edfb58b062a0017d419,
title = "Medical health care utilization cost of patients presenting with psychogenic nonepileptic seizures",
abstract = "Objective: To investigate the health care utilization cost of patients presenting with psychogenic nonepileptic seizures (PNES) to a tertiary hospital in Australia. Methods: This is a retrospective analysis of adult patients with PNES based on video-electroencephalographic confirmation over a 5-year period. We used an itemized list to collect detailed health care utilization data. The items included emergency room visits, hospital ward admissions, intensive care unit (ICU) admissions, outpatient neurology clinic visits, medical interventions, Code Blue and Medical Emergency Team calls for seizures, medications, and investigations. We calculated the cost of each individual item separately for each individual presentation. To investigate the proportional contribution of each covariate toward the total health care utilization cost, an analysis of the relative importance in the linear regression was performed. Results: There were 39 patients, of whom seven (18{\%}) were admitted to the ICU with suspected status epilepticus. The median total health care utilization cost per person until the diagnosis of PNES was established as 26 468 Australian dollars (AUD; 19 207 US dollars [USD]). In the item breakdown, the highest median cost was incurred by investigations (13 119 AUD = 9520 USD), followed by hospital ward management (8890 AUD = 6451 USD), ICU stay (3764 AUD = 2731 USD), outpatient neurology clinics (2200 AUD = 1596 USD), and emergency room visits (570 AUD = 413 USD). Nonepileptic psychogenic status (23{\%}) and the duration of PNES disorder (10{\%}) were the most significant variables contributing to the variance (R2) of the model. Significance: A considerable burden of health care utilization cost is caused by PNES. The presence of nonepileptic psychogenic status and a longer duration of the condition predict a higher cost.",
keywords = "cost-effectiveness, epilepsy monitoring, medical care, psychogenic nonepileptic seizures, status epilepticus",
author = "Udaya Seneviratne and Low, {Zhi Mei} and Low, {Zhi Xuen} and Angela Hehir and Sahira Paramaswaran and Monica Foong and Henry Ma and Phan, {Thanh G.}",
year = "2019",
month = "2",
day = "1",
doi = "10.1111/epi.14625",
language = "English",
volume = "60",
pages = "349--357",
journal = "Epilepsia",
issn = "0013-9580",
publisher = "John Wiley & Sons",
number = "2",

}

Medical health care utilization cost of patients presenting with psychogenic nonepileptic seizures. / Seneviratne, Udaya; Low, Zhi Mei; Low, Zhi Xuen; Hehir, Angela; Paramaswaran, Sahira; Foong, Monica; Ma, Henry; Phan, Thanh G.

In: Epilepsia, Vol. 60, No. 2, 01.02.2019, p. 349-357.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Medical health care utilization cost of patients presenting with psychogenic nonepileptic seizures

AU - Seneviratne, Udaya

AU - Low, Zhi Mei

AU - Low, Zhi Xuen

AU - Hehir, Angela

AU - Paramaswaran, Sahira

AU - Foong, Monica

AU - Ma, Henry

AU - Phan, Thanh G.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Objective: To investigate the health care utilization cost of patients presenting with psychogenic nonepileptic seizures (PNES) to a tertiary hospital in Australia. Methods: This is a retrospective analysis of adult patients with PNES based on video-electroencephalographic confirmation over a 5-year period. We used an itemized list to collect detailed health care utilization data. The items included emergency room visits, hospital ward admissions, intensive care unit (ICU) admissions, outpatient neurology clinic visits, medical interventions, Code Blue and Medical Emergency Team calls for seizures, medications, and investigations. We calculated the cost of each individual item separately for each individual presentation. To investigate the proportional contribution of each covariate toward the total health care utilization cost, an analysis of the relative importance in the linear regression was performed. Results: There were 39 patients, of whom seven (18%) were admitted to the ICU with suspected status epilepticus. The median total health care utilization cost per person until the diagnosis of PNES was established as 26 468 Australian dollars (AUD; 19 207 US dollars [USD]). In the item breakdown, the highest median cost was incurred by investigations (13 119 AUD = 9520 USD), followed by hospital ward management (8890 AUD = 6451 USD), ICU stay (3764 AUD = 2731 USD), outpatient neurology clinics (2200 AUD = 1596 USD), and emergency room visits (570 AUD = 413 USD). Nonepileptic psychogenic status (23%) and the duration of PNES disorder (10%) were the most significant variables contributing to the variance (R2) of the model. Significance: A considerable burden of health care utilization cost is caused by PNES. The presence of nonepileptic psychogenic status and a longer duration of the condition predict a higher cost.

AB - Objective: To investigate the health care utilization cost of patients presenting with psychogenic nonepileptic seizures (PNES) to a tertiary hospital in Australia. Methods: This is a retrospective analysis of adult patients with PNES based on video-electroencephalographic confirmation over a 5-year period. We used an itemized list to collect detailed health care utilization data. The items included emergency room visits, hospital ward admissions, intensive care unit (ICU) admissions, outpatient neurology clinic visits, medical interventions, Code Blue and Medical Emergency Team calls for seizures, medications, and investigations. We calculated the cost of each individual item separately for each individual presentation. To investigate the proportional contribution of each covariate toward the total health care utilization cost, an analysis of the relative importance in the linear regression was performed. Results: There were 39 patients, of whom seven (18%) were admitted to the ICU with suspected status epilepticus. The median total health care utilization cost per person until the diagnosis of PNES was established as 26 468 Australian dollars (AUD; 19 207 US dollars [USD]). In the item breakdown, the highest median cost was incurred by investigations (13 119 AUD = 9520 USD), followed by hospital ward management (8890 AUD = 6451 USD), ICU stay (3764 AUD = 2731 USD), outpatient neurology clinics (2200 AUD = 1596 USD), and emergency room visits (570 AUD = 413 USD). Nonepileptic psychogenic status (23%) and the duration of PNES disorder (10%) were the most significant variables contributing to the variance (R2) of the model. Significance: A considerable burden of health care utilization cost is caused by PNES. The presence of nonepileptic psychogenic status and a longer duration of the condition predict a higher cost.

KW - cost-effectiveness

KW - epilepsy monitoring

KW - medical care

KW - psychogenic nonepileptic seizures

KW - status epilepticus

UR - http://www.scopus.com/inward/record.url?scp=85058953180&partnerID=8YFLogxK

U2 - 10.1111/epi.14625

DO - 10.1111/epi.14625

M3 - Article

VL - 60

SP - 349

EP - 357

JO - Epilepsia

JF - Epilepsia

SN - 0013-9580

IS - 2

ER -