Super-Refractory Status Epilepticus Poses a Significant Health and Economic Burden

Child ICU
Child ICU
On average, pediatric patients spent more time in the ICU and accounted for a larger hospitalization cost.

Super-refractory status epilepticus (SRSE) is associated with high rates of morbidity, mortality, and use of health care resources, according to a cross-sectional study published in the Journal of Medical Economics.

SRSE is status epilepticus that persists beyond 24 hours despite third-line antiepileptic agents. It is estimated that approximately 10 to 15% of patients with status epilepticus progress into SRSE.

Because there is limited research on the incidence and economic burden of SRSE, Lidia M. V. R. de Moura, MD, MPH, of Massachusetts General Hospital in Boston, and colleagues analyzed data from the Premier Hospital Database  on patients with a seizure ICD-9 code with 2 days of treatment in the intensive care unit, intravenous antiepileptic drugs, and mechanical ventilation or a status epilepticus diagnosis.

The investigators identified 6325 cases that met criteria for SRSE, including 462 pediatric cases, representing 4% of all seizure-related hospitalizations.  Notably, 19% and 5% of adult and pediatric patients with SRSE, respectively, died, with a mortality rate of 18% overall.  Comorbidities commonly reported included acute respiratory failure, hypertension, and hypokalemia.

Based on 2012 demographics, the investigators estimated there were 41,156 cases of SRSE in the United States that year (6% or 2439 cases in children). This would translate to an approximate SRSE incidence of 13/100,000 per year. The incidence was reduced to 11/100,000 per year and 8/100,000 per year when the algorithm included 3 or more days in the ICU and an EEG charge, respectively.

The mean length of stay for SRSE hospitalizations was 16.5 days (median 11 days, IQR 6-20 days) and 9.3 days in the ICU (median 6 days, IQR 3-12 days). Pediatric patients had and overall  longer mean length of stay (20 days, median 12, IQR 5-26) than adults (16.3 days, median 11, IQR 6-19), with more time spent in the ICU as well (mean LOS 12.7 vs 9 days). Patients with SRSE received an average of 5 antiepileptic drugs.

The mean cost of SRSE hospitalizations was $51,247 (95% CI: $49,634-$52,861), with pediatric patients having a higher mean cost ($73,230 vs $49,515). Adult and pediatric patients had an average cost per day of $3,400 and $3,860, respectively. Commercial insurance paid for18% of discharges, with Medicare and Medicaid being the most common payer for adults and children, respectively.

The study was limited by its cross-sectional nature and its analysis of data based on ICD-9 codes and insurance claims information. Further, the mortality rate of SRSE may be underestimated because the data did not include patients who died before the 2 day hospitalization criteria and there was no mortality data after discharge.

“This study suggests that SRSE is associated with high mortality and morbidity, and significant use of health care resources,” the authors concluded.

Disclosures: The study was funded by Sage Therapeutics, Inc. Authors Jamil Beg, Thomas Anderson, Lisa Meckley, and Stephen Kane reported financial relationships with Sage Therapeutics.

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Beg JM, Anderson TD, Francis K, et al. Burden of illness for super-refractory status epilepticus patients. J Med Econ. 2016 Aug 23;1-9. doi:10.1080/13696998.2016.1223680.