Rationale:
Epilepsy is considered by the World Health Organization as the most common serious neurological condition affecting children. Thirty percent will develop drug resistant epilepsy (DRE) who require comprehensive care and represents a significant financial burden not only for the health care system but for the families as well. In the US, the associated cost with epilepsy care is $15.5 billion USD annually. In London, Ontario, the Comprehensive Epilepsy Clinic (CEC) is a specialized multi-disciplinary and inter-professional clinic model within the epilepsy program that provides advanced therapies as well as facilitates access to health disciplines and resources for each family. As part of a program evaluation, a focused cost-benefit analysis was conducted to determine if this clinic model impacts the economic burden for the healthcare system and families.
Methods:
We collected data from Children’s Hospital, London Health Sciences Centre analytics department identifying 70 new consults to the CEC in the year 2020. We looked at epilepsy related hospital utilization 365 days +/- the CEC consult date for each patient. This included emergency room visits, inpatient admissions, critical care admissions and telephone encounters with the epilepsy nurse. Hospital associated costs did not include human resources or advanced diagnostics. We ran a secondary analysis to account for family expenses while in the hospital which include loss of income for one parent, daycare, parking, and food expense.
Results:
Emergency room (ER) visits pre-CEC consult for the 70 families were 198 and post consult 87 with an average cost calculated at $325 CAD for the system and $388 CAD for the family. Inpatient admissions went from 48 to 39 with an average length of stay of 4.1 days costing $4888 CAD for the system and $1552 CAD for families per visit. Critical care admissions went from 7 to 4, with an average length of stay of 2.6 days costing $9644 CAD to the system and $1009 CAD for families per visit. Telephone calls with an epilepsy nurse for advice and education for families went from 38 to 161, with no associated cost to the system or to families. In total, there was a 56% cost reduction for ER visits, 19% for inpatient admissions, and 43% reduction for critical care admissions in cost to the system and families post CEC consult.
Conclusions:
A comprehensive epilepsy clinic model appears to reduce the financial burden to both the healthcare system and families of children living with DRE. This model could be replicated and beneficial in under-serviced and low-income countries as a means to provide epilepsy resources and care in an efficient way including access to an epilepsy nurse to provide extensive education and support to families.
Funding: This research was a part of the LHSC Academic Realignment Initiative