Analysis of the reasons and costs of hospitalization for epilepsy patients in East China

Inpatient Burden of Neurological Disorders: A Route Map for Allocation of Resources and Postgraduate Training

Introduction There are limited data regarding the profile of inpatient neurological disorders in India. Understanding the spectrum of diseases and the profile of patients admitted in an inpatient setting will help to streamline services, allocate resources, develop management protocols, design curricula, and improve training programs of postgraduate students in neurology training. Objective The objective of this study is to study the profile of inpatient neurological disorders in 1000 consecutive patients admitted to a tertiary care neurological center. Methods Data from 1000 consecutive inpatients admitted to the Neurology Department at St. John's Medical College Hospital, Bengaluru from January 2018 to October 2018 were collected from the medical records. The data obtained from the case records were entered into a Microsoft Excel spreadsheet for descriptive analysis. Results The average age of the patients was 48 years (±18.18) and 606 of the 1000 patients were males. Strokes, including arterial and venous strokes, formed the major inpatient caseload, accounting for 48.7% of cases. Of these, 84% had ischemic arterial strokes, 7.4% had intracranial hemorrhage, and 8.4 % had cerebral sinus venous strokes; 19.3% of patients were admitted for seizures while 8.2% of patients were admitted for headache. Meningitis was diagnosed in 5.2% of patients; 4.8% of patients had central nervous system demyelinating and autoimmune diseases. A number of other diagnoses comprised less than 2.5% each and included movement disorders, peripheral nerve, spine and nerve roots disorders, neuromuscular diseases, neurodegenerative diseases, and medical and functional illness. Conclusion The most common disorders in the inpatient setting are stroke, seizure, headache, meningitis, and autoimmune/demyelinating disorders. These disorders should receive priority while planning the allocation of resources, educational curriculum, training, and teaching programs.

Epilepsy hospitalizations and mental disorders: A Portuguese population-based observational retrospective study (2008-2015)

BACKGROUND

Psychiatric comorbidities are highly frequent in people with epilepsy and were found to be markers of poorer prognosis. These comorbidities increase the use of healthcare resources, including emergency department visits and inpatient care. Despite this, there is little information on healthcare utilization associated with a wide range of comorbid mental disorders in people with epilepsy (PWE).

OBJECTIVE

To characterize registered mental disorders among all hospitalizations with a primary diagnosis of epilepsy and to analyze their association with crucial hospitalization outcomes.

METHODS

An observational retrospective study was performed using administrative data from hospitalization episodes with epilepsy as the primary diagnosis discharged between 2008 and 2015. Mental disorder categories 650 to 670 from Clinical Classification Software were selected as secondary diagnoses. Mann-Whitney U, Kruskall-Wallis, and Chi-squared tests were used to establish comparisons. For each episode, data regarding hospitalization outcomes was retrieved, including length of stay (LoS), in-hospital mortality (IHM), 8-year period readmissions, and total estimated charges.

RESULTS

Overall, 27,785 hospitalizations were analyzed and 33.9% had registered mental disorders, with alcohol-related disorders being the most prevalent (11.7%). For episodes with a concomitant register of a mental disorder, LoS was significantly longer (5.0 vs. 4.0 days, P <0.001), and IHM was higher (2.8% vs. 2.2%, P <0.001), as were readmissions (25.5% vs. 23.7%, P <0.001), and median episodes' charges (1,578.7 vs. 1,324.4 euros, P <0.001).

CONCLUSION

Epilepsy-related hospitalizations with registered mental disorders heightened the utilization of healthcare resources, stressing the importance of diagnosing and treating mental disorders in PWE.

Evaluation of the direct costs of epilepsy in a sample of Egyptian patients following up in Ain Shams University Hospital

Background

Epilepsy is a chronic disorder of the brain, and it is considered as the 4th common neurological disorder. Epilepsy is associated with an economic burden by imposing a significant burden on both the individuals who have the condition and on those around them, as well as for the society.

Objective

Our objective is to study and evaluate the direct costs associated with the medical management of epilepsy, one of the most common neurological conditions.

Methods

Observational, cross-sectional 4-month study started in December 2018 till April 2019 in patients between 2 and 60 years of age with epilepsy without other concomitant diseases. The direct medical costs include the number of neurology and emergency room visits, number and type of diagnostic tests, days of hospitalization, and treatment administered for epilepsy.

Results

We studied data from 194 patients, with a mean age of 30.6 years; the mean cost for treatment with carbamazepine was 78.6 Egyptian pound (EGP); for valproate, the cost was 288.4 EGP, and for levetiracetam, the cost was 491 EGP. The mean cost of electroencephalogram (EEG) is 108 EGP, and for computer tomography scan (CT) of the brain and magnetic resonance imaging (MRI) of the brain, it is 149.4 and 423.7 EGP respectively. The mean cost for hospitalization was 610.5 EGP, and the cost for intensive care unit (ICU) stay was 515.4 EGP.

Conclusion

The economic cost of epilepsy constitutes a major burden for the patients as well as their families; most of the direct cost was attributed to the purchase of AEDs. This necessitates creating strategies to ensure regular access to affordable AEDs as well as introducing other varieties of AEDs more potent with less side effects.