Abstracts

Status epilepticus(SE) direct medical costs and reimbursement by hospital diagnostic related groups(DRGs) have not been studied. Such information is important in order to quantify the economic burden of SE and argue for stronger preventive measures and effective early intervention.
All patients admitted via the emergency room or a direct transfer to Mayo Clinic Hospital with EEG confirmed SE from 1/1/02 to12/ 31/02 were identified by chart review. Age, gender, etiology, time to first pharmacological intervention, length of stay (LOS), outcome and presence of refractory SE (RSE) were abstracted for analysis. Patient financial statements were then analyzed and adjusted for actual cost (eliminating markup) for: total hospital charges, average charge per day, percent of costs attributed to various aspects of medical care, and maximal DRG reimbursement. Difference between the account and DRG payment was the net loss/gain. A subanalysis of RSE patient costs was performed. Patients admitted for epilepsy monitoring were not included in this analysis.
Eighteen patients were admitted to Mayo Clinic Hospital in SE, consisting of 11 females and 7 males with an average age of 56 years (range 17-86). Ten of the 18 (55%) had RSE. Etiologies of status included stroke (5), hypoxia (3), tumors (2), low antiepileptic drug levels (3), CNS infections (3) and metabolic causes (2). Four (22%) of the 18 died. Seventeen (94.4%) had been seizing for at least 4 hours before any drug intervention. Average LOS was 13.23 days (range 3- 71 days) with a mean length of RSE admissions of 19.2 days. Average cost/day was $6412 for all SE cases and $6201 for RSE. This resulted in a mean total charge of $88,256/patient (range=$5,058-$515,085) overall and $118,577 for RSE patients. Intravenous medications accounted for the largest cost allocation (27%) followed by intensive care and emergency room use (21%) and room and board (14%). EEG and Neurologist fees contributed least to direct costs representing 1.54%. Total charges for all cases were $1,305,872. Only 1/18 SE admissions were fully covered by the DRG. The average loss for each admission was $65,258 overall (range $ 6030 favorable - $439,849 loss) and $87,284 for RSE cases. Total loss of all SE patients not covered by DRG coding amounted to $910,512.
SE costs adversely impact patients and health care institutions with finite resources. EEGs represent a small fraction of SE care and its use is encouraged for rapid diagnosis because shorter duration of SE leads to better outcomes. Public and professional health education needs to focus on prevention, early diagnosis and treatment of SE. These data can serve as part of a cost/benefit analysis to gauge whether rapid access to early therapy would reduce costs of SE care. A separate [quot]SE[quot] DRG should be considered reflecting actual costs and LOS.
[Supported by: Mayo School of CME: Guidelines in Applied Practice (GAP)Initiative]