Abstracts

Rationale: While rising healthcare costs are a concern for many, the financial burden on people with epilepsy (PWE) can further exacerbate unmet needs. We describe the trend of average daily charges in PWE over a 12 year period as well as the trend of length of inpatient hospitalizations. Methods: Data from a population based, statewide, retrospective cohort study of PWE seen in SC non-federal hospitals and emergency departments from 2000-2011 were analyzed. Average charge per day was generated for inpatient, outpatient, and emergency department visits; inpatient length of stay was also described. PWE were described in terms of demographic and clinical characteristics, including the presence of common comorbidities of epilepsy. Generalized linear modeling was used to test for a trend in charges and inpatient length of stay over time accounting for demographic and clinical characteristics. Results: 64877 PWE had ~1.3 million ED, inpatient and outpatient visits over the 12 year period Daily charges for an ED, inpatient or outpatient visit averaged $1670, $5157 and $4100, respectively. The average length of inpatient stay was 5.2 days. When analyzed by discharge year, the average daily charges showed a statistically significant positive trend (P<0.01) with an estimated $243 increase in charges each year. The length of inpatient stay also showed a significant positive trend (P<0.01) although the increase in inpatient days was very small (0.03 days per year). Between 2000 and 2012, the average daily charge for an ED visit increased 340% while daily inpatient and outpatient charges increased 140% and 100%, respectively. After adjusting for demographic characteristics, charges for inpatient and outpatient visits increased by $3454 and $2328, respectively compared with ED visits. Charges increased with increasing age and were slightly higher for males. Compared with those with commercial insurance, charges were lower for the uninsured ($246 less) and those covered by Medicare ($237 less) and Medicaid ($220 less). Increasing numbers of comorbid conditions increased the charges; after adjusting for other covariables the average daily charge increased from $3330 for PWE no diagnosis of the common comorbidities of epilepsy to $3500 in PWE with 6 or more. Conclusions: Over the 12 years of data, daily charges have increased while the length of inpatient stay has remained constant. While these documented charges closely approximate actual costs to patients or insurers, early diagnosis and management of comorbid conditions are important measures that reduce the rising healthcare cost in epilepsy.