title: Costs and cost-driving factors for acute treatment of adults with status epilepticus: A multicenter cohort study from Germany.
abstract: To 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).
  
  
  
  In 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.
  
  
  
  We evaluated 341 admissions in 316 patients (65.7 ± [standard deviation]18.2 years; 135 male) treated for SE. Mean costs of hospital treatment were €14,946 (median €5,278, range €776-€152,911, €787 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 €8,314 in NSE (n = 137, median €4,597, €687 per treatment day, 22.3% of total inpatient costs due to SE), €13,399 in RSE (n = 171, median €7,203, €638/day, 45.0% of total costs, p < 0.001), and €50,488 in SRSE (n = 33, median €46,223, €1,365/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%).
  
  
  
  Acute 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 >€200 million per year. Along with the demographic change, incidence of SE will increase and costs for hospital treatment and sequelae of SE will rise.
authors.affiliation: Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe-University, Frankfurt am Main, Germany.|Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany.
authors.forename: Lena-Marie
authors.initials: LM
authors.lastname: Kortland
authors.affiliation: Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Alfter
authors.affiliation: Senckenberg Institute of Neurooncology, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Bähr
authors.affiliation: Department of Neurosurgery, Philipps-University, Marburg, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Carl
authors.affiliation: Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany.|Department of Geriatrics, University Duisburg-Essen, Essen, Germany.
authors.forename: Richard
authors.initials: R
authors.lastname: Dodel
authors.affiliation: Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Freiman
authors.affiliation: Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Kristina
authors.initials: K
authors.lastname: Hubert
authors.affiliation: Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Kolja
authors.initials: K
authors.lastname: Jahnke
authors.affiliation: Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Knake
authors.affiliation: Department of Neurology and Epilepsy Center, Ernst-Moritz-Arndt-University, Greifswald, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: von Podewils
authors.affiliation: Institute of Health Service Research and Clinical Epidemiolgy and Coordinating Center for Clinical Trials, Philipps-University, Marburg, Germany.
authors.forename: Jens-Peter
authors.initials: JP
authors.lastname: Reese
authors.affiliation: Department of Neurology and Epilepsy Center, Ernst-Moritz-Arndt-University, Greifswald, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Runge
authors.affiliation: Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Senft
authors.affiliation: Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Helmuth
authors.initials: H
authors.lastname: Steinmetz
authors.affiliation: Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe-University, Frankfurt am Main, Germany.|Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Rosenow
authors.affiliation: Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe-University, Frankfurt am Main, Germany.|Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany.
authors.forename: Adam
authors.identifier: 0000-0001-6288-9915
authors.initials: A
authors.lastname: Strzelczyk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D005858:Germany; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D013226:Status Epilepticus / Q000191:economics* / Q000628:therapy*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Cost; Economic burden; Epilepsy; Status epilepticus