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.