title: Cost of status epilepticus in a tertiary care hospital in India.
abstract: OBJECTIVE
  Status epilepticus (SE) is one of the most important neurological emergencies. The present study evaluated both direct cost of SE and predictors of cost in an Indian tertiary care teaching hospital in Lucknow India.
  
  
  METHODS
  SE was defined as continuous seizure for ≥ 5 min or recurrent seizures without regaining consciousness. Etiologies of SE were categorized as acute central nervous system (CNS) pathology, acute non-CNS pathology, chronic CNS pathology, congenital disorders and others. Patients requiring mechanical ventilation (MV) received ventilators free of cost. Mortality and disability on discharge were noted.
  
  
  RESULTS
  Fifty-five patients aged 8-90 years were included (males, 33). Fifty (89.3%) patients had generalized convulsive SE. The severity of SE as assessed by Status Epilepticus Scoring Scale was unfavorable (score, 3-6) in 41 (74.5%) patients. The etiology of SE was categorized as acute CNS pathology in 28 (51%) patients, non-CNS and chronic CNS pathology in 11 (19.6%) patients each, remote congenital pathology in 2 (3.6%), and others in 3 (5.6%). Thirty (53.6%) patients had comorbidities. Median duration of hospitalization was 7 (range, 1-72) days.Twenty six patients were hospitalized for >7 days. SE was controlled by 2 drugs in 47 (85.5%) patients and refractory to 2 intravenous antiepileptic drugs in 8 (14.5%). Nineteen (34.5%) patients died, and 29 (51.8%) showed favorable outcomes on discharge. Median hospital expenditure per case was INR 19,900 ($309.87; range, INR 1600-574,000). On multivariate analysis, SE hospitalization costs were determined by refractoriness of SE and mechanical ventilation (MV). Hospitalization cost of SE was lower than those of stroke.
  
  
  CONCLUSIONS
  Acute non-CNS pathology is largely responsible for the high cost of SE, particularly refractory SE requiring mechanical ventilation.
authors.affiliation: Department of Neurology Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. Electronic address: drukmisra@rediffmail.com.
authors.forename: Usha K
authors.initials: UK
authors.lastname: Misra
authors.affiliation: Department of Neurology Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Jayantee
authors.initials: J
authors.lastname: Kalita
authors.affiliation: Department of Neurology Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Sanjeev K
authors.initials: SK
authors.lastname: Bhoi
authors.affiliation: Department of Neurology Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Deepanshu
authors.initials: D
authors.lastname: Dubey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000191:economics / Q000627:therapeutic use; D002648:Child; D015897:Comorbidity; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012121:Respiration, Artificial / Q000191:economics; D013226:Status Epilepticus / Q000191:economics* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D062606:Tertiary Care Centers / Q000191:economics*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Cost; Disability; India; Mortality; Predictors; Status epilepticus