Autoimmune encephalitis A costly condition
Por:
Cohen, J, Sotoca, J, Gandhi, S, Yeshokumar, AK, Gordon-Lipkin, E, Geocadin, RG, Frick, KD, Probasco, JC, Venkatesan, A
Publicada:
26 feb 2019
Resumen:
Objective
To assess the inpatient hospitalization burden and costs of patients with autoimmune encephalitis (AE) at a tertiary care institution.
Methods
Adult inpatients with AE were identified retrospectively from July 1, 2005, to June 30, 2015. Demographic and clinical data were collected and analyzed. Billing data were compared to those of patients with herpes simplex encephalitis (HSE). Charges were adjusted for inflation.
Results
Of 244 admissions for encephalitis reviewed, 63 patients met criteria for probable or definite AE. Thirty-one (49%) patients were antibody positive, and 27 (43%) were admitted to the intensive care unit (ICU). Median hospital charges per patient with AE were more than $70,000; median length of stay (LOS) was 15 days; and in-hospital mortality was 6%. Patients admitted to the ICU had substantially higher median hospital charges (ICU $173,000 per admission vs non-ICU $50,000 per admission, p < 0.001). LOS was strongly associated with charges and was driven by delay in diagnosis of AE, prolonged treatment courses, and lack of response to therapy. Compared with HSE, median hospital charges per patient with AE were nearly 4 times higher, median AE LOS was 3 times higher, and total charges over the study period were nearly twice as high.
Conclusions
Patients with AE used more inpatient health care resources per patient during a 10-year period than patients with HSE at our institution. ICU-admitted patients with AE were responsible for a substantially higher financial burden than non-ICU-admitted patients with AE. Our data underscore the need for the development of novel diagnostic and therapeutic modalities to improve patient outcomes and to decrease hospital burden in AE.
Filiaciones:
Cohen, J:
Johns Hopkins Univ, Sch Med, Dept Neurol, Johns Hopkins Encephalitis Ctr, Baltimore, MD 21205 USA
Sotoca, J:
Hosp Santa Creu & Sant Pau, IIB St Pau, Dept Neurol, Barcelona, Spain
Gandhi, S:
Johns Hopkins Univ, Sch Med, Dept Neurol, Johns Hopkins Encephalitis Ctr, Baltimore, MD 21205 USA
Yeshokumar, AK:
Icahn Sch Med Mt Sinai, Dept Neurol & Pediat, New York, NY 10029 USA
Gordon-Lipkin, E:
Johns Hopkins Univ, Sch Med, Dept Neurol, Johns Hopkins Encephalitis Ctr, Baltimore, MD 21205 USA
Kennedy Krieger Inst, Dept Neurol & Dev Med, Baltimore, MD USA
Geocadin, RG:
Johns Hopkins Univ, Sch Med, Dept Neurol, Johns Hopkins Encephalitis Ctr, Baltimore, MD 21205 USA
Johns Hopkins Univ, Sch Med, Dept Neurosurg, Baltimore, MD 21205 USA
Johns Hopkins Univ, Sch Med, Dept Anaesthesia Crit Care, Baltimore, MD 21205 USA
Frick, KD:
Johns Hopkins Carey Business Sch, Baltimore, MD USA
Probasco, JC:
Johns Hopkins Univ, Sch Med, Dept Neurol, Johns Hopkins Encephalitis Ctr, Baltimore, MD 21205 USA
Venkatesan, A:
Johns Hopkins Univ, Sch Med, Dept Neurol, Johns Hopkins Encephalitis Ctr, Baltimore, MD 21205 USA
|