title: Decreased health care utilization and health care costs in the inpatient and emergency department setting following initiation of ketogenic diet in pediatric patients: The experience in Ontario, Canada.
abstract: To assess the change in inpatient and emergency department utilization and health care costs in children on the ketogenic diet for treatment of epilepsy.
  
  
  
  Data on children with epilepsy initiated on the ketogenic diet (KD) Jan 1, 2000 and Dec 31, 2010 at Ontario pediatric hospitals were linked to province wide inpatient, emergency department (ED) data at the Institute for Clinical Evaluative Sciences. ED and inpatient visits and costs for this cohort were compared for a maximum of 2 years (730days) prior to diet initiation and for a maximum of 2 years (730days) following diet initiation. KD patient were compared to matched group of children with epilepsy who did not receive the ketogenic diet (no KD).
  
  
  
  Children on the KD experienced a mean decrease in ED visits of 2.5 visits per person per year [95% CI (1.5-3.4)], and a mean decrease of 0.8 inpatient visits per person per year [95% CI (0.3-1.3)], following diet initiation. They had a mean decrease in ED costs of $630 [95% CI (249-1012)] per person per year and a median decrease in inpatient costs of $1059 [IQR: 7890; p<0.001] per child per year. Compared with the no KD children, children on the diet experienced a mean reduction of 2.1 ED visits per child per year [95% CI (1.0-3.2)] and a mean decrease of 0.6 [95% CI (0.1-1.1)] inpatient visits per child per year. Patients on the KD experienced a reduction of $442 [95% CI (34.4-850)] per child per year more in ED costs than the matched group. The ketogenic diet group had greater median decrease in inpatient costs per child per year than the matched group [p<0.001].
  
  
  
  Patients initiated on ketogenic diet, experienced decreased ED and inpatient visits as well as costs following diet initiation in Ontario, Canada.
authors.affiliation: Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada. Electronic address: whiting@cheo.on.ca.
authors.forename: Sharon
authors.initials: S
authors.lastname: Whiting
authors.affiliation: Hospital for Sick Children, Toronto, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Donner
authors.affiliation: McMaster Children's Hospital, Hamilton, Canada.
authors.forename: Rajesh
authors.initials: R
authors.lastname: RamachandranNair
authors.affiliation: Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Grabowski
authors.affiliation: Department of Clinical Neurosciences, Hochkiss Brain Institute, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Jetté
authors.affiliation: Institute for Clinical Evaluative Sciences, Ontario, Canada.
authors.forename: Daniel Rodriguez
authors.initials: DR
authors.lastname: Duque
mesh_terms: D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual / Q000639:trends; D055423:Diet, Ketogenic / Q000191:economics* / Q000639:trends; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D004827:Epilepsy / Q000178:diet therapy / Q000191:economics* / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs / Q000639:trends; D006760:Hospitalization / Q000191:economics* / Q000639:trends; D006801:Humans; D007223:Infant; D008297:Male; D009864:Ontario / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies
keywords: Epilepsy; Health care costs; Health care utilization; Ketogenic diet