Costs and cost-driving factors for acute treatment of adults with status epilepticus: A multicenter cohort study from Germany

ObjectiveTo provide first data on inpatient costs and cost-driving factors due to nonrefractory status epilepticus (NSE), refractory status epilepticus (RSE), and super-refractory status epilepticus (SRSE). MethodsIn 2013 and 2014, all adult patients treated due to status epilepticus (SE) at the university hospitals in Frankfurt, Greifswald, and Marburg were analyzed for healthcare utilization. ResultsWe evaluated 341 admissions in 316 patients (65.7 [standard deviation]18.2 years; 135 male) treated for SE. Mean costs of hospital treatment were Euro14,946 (median Euro5,278, range Euro776-Euro152,911, Euro787 per treatment day) per patient per admission, with a mean length of stay (LOS) of 19.0 days (median 14.0, range 1-118). Course of SE had a significant impact on mean costs, with Euro8,314 in NSE (n = 137, median Euro4,597, Euro687 per treatment day, 22.3% of total inpatient costs due to SE), Euro13,399 in RSE (n = 171, median Euro7,203, Euro638/day, 45.0% of total costs, p < 0.001), and Euro50,488 in SRSE (n = 33, median Euro46,223, Euro1,365/day, 32.7% of total costs, p < 0.001). Independent cost-driving factors were SRSE, ventilation, and LOS of >14 days. Overall mortality at discharge was 14.4% and significantly higher in RSE/SRSE (20.1%) than in NSE (5.8%). SignificanceAcute treatment of SE, and particularly SRSE and ventilation, are associated with high hospital costs and prolonged LOS. Extrapolation to the whole of Germany indicates that SE causes hospital costs of >Euro200 million per year. Along with the demographic change, incidence of SE will increase and costs for hospital treatment and sequelae of SE will rise.