ABSTRACT
Background@#Status epilepticus (SE) is a neurological emergency requiring prompt evaluation and management to prevent disease refractoriness associated with significant mortality and morbidity. Thus, estimating costs attributable to the treatment of SE is important because of the severity of this disease. In the Philippines, healthcare provisions are mostly out-of-pocket expenses; hence the cost of treatment is a critical determinant for disease management. Unfortunately, the availability of data regarding the cost of illness of SE in developing countries is limited.@*Objectives@#To determine the frequently used anticonvulsant drug regimen and direct inpatient costs of acute treatment for status epilepticus within five years in a private tertiary hospital in the Philippines.@*Methods@#Records from patients diagnosed with SE who were admitted under or referred to the Adult Neurology Service in a private tertiary hospital from January 2015 to December 2019 were retrospectively evaluated. The SE type was classified as non-refractory (NRSE), refractory (RSE), and super refractory (SRSE). Demographic data, clinical features, SE type, etiology, antiepileptic drugs (AEDs) and anesthetic drugs used, total cost of AEDs and anesthetic drugs, total cost of 5-day hospitalization, and total cost of entire length of stay were recorded.@*Results@#We retrieved the records of 61 patients admitted for SE. Of these patients, 23 were classified as nonrefractory, 20 as refractory, and 18 as super refractory. Diazepam was given to all SE patients as first-line treatment. Valproic acid and levetiracetam were used as second-line treatments. The most frequently given anesthetic drug was midazolam. The mean hospitalization cost per patient was ₱52,0982.3 for SE, ₱659,638.7 for RSE, and ₱134,1451 for SRSE. The mean cost of 5-day hospitalization was ₱193,572.3 for NRSE, ₱358,808.5 for RSE, and ₱652,781 for SRSE. The mean cost of medications was ₱18,546 for NRSE, ₱30,780 for RSE, and ₱128,263 for SRSE.@*Conclusion@#The direct cost of SE varied depending on subtype and response to treatment. Costs increased with disease refractoriness. Direct inpatient treatment costs for SRSE were twice as high as that of NRSE and RSE.
Subject(s)
Epilepsy , Status Epilepticus , HospitalizationABSTRACT
PURPOSE@#Super refractory status epilepticus (SRSE) is an uncommon, but important clinical problem with high morbidity and mortality. Studies concerning SRSE has been limited and there are no existing Philippine data. The study aims to determine the status of Refractory (RSE) and SRSE within a 10-year period in a Tertiary Hospital.@*METHODS@#This is a retrospective study of adult patients with prolonged seizures admitted at The Medical City, Philippines from January 2009- July 2018. Multinomial Logistic Regression was used to assess probability of good or poor outcome. Significant Correlation is defined by P value of <0.05. @*RESULTS@#The Incidence of RSE is as high as 38% (n=64) and 35% (n=58) for SRSE. Mortality rate is 39.1% in RSE and 62.1% in SRSE. Poor functional outcome is observed in RSE and SRSE wherein the majority was Alive Dependent. Significant factor increasing likelihood of being Alive Dependent is the absence of Arrest. @*CONCLUSION@#Factors associated with likelihood of being alive and independent includes Status Epilepticus and younger age therefore aggressive seizure control to prevent progression to SRSE will give higher likelihood of good functional outcome and elderly patients warrant closer and more adept seizure control for better functional outcome.