Burden of status epilepticus: prognosis and cost driving factors, insight from a nationwide retrospective cohort study of the French health insurance database

• Published in: Journal of neurology 2024-10, Vol.271 (10), p.6761-6772
• Main Authors: Calonge, Quentin, Le Gac, François, Chavez, Mario, Degremont, Adeline, Quantin, Catherine, Tubach, Florence, du Montcel, Sophie Tezenas, Navarro, Vincent
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Cognitive science; Cohort analysis; Cohort Studies; Comorbidity; Cost of Illness; Databases, Factual; Epilepsy; Female; France - epidemiology; Health Care Costs - statistics & numerical data; Health insurance; Hospital costs; Hospital Mortality; Hospitalization; Hospitalization - economics; Hospitalization - statistics & numerical data; Humans; Hypoxia; Insurance, Health - economics; Insurance, Health - statistics & numerical data; Life Sciences; Long-term effects; Male; Mechanical ventilation; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neurology; Neuroradiology; Neuroscience; Neurosciences; Original Communication; Patients; Prognosis; Respiration, Artificial - economics; Respiration, Artificial - statistics & numerical data; Retrospective Studies; Santé publique et épidémiologie; Status Epilepticus - economics; Status Epilepticus - epidemiology; Status Epilepticus - etiology; Status Epilepticus - mortality; Status Epilepticus - therapy; Ventilators; Young Adult
• ISSN: 0340-5354; 1432-1459; 1432-1459
• DOI: 10.1007/s00415-024-12589-6

Background Status epilepticus (SE) imposes a significant burden in terms of in-hospital mortality and costs, but the relationship between SE causes, patient comorbidities, mortality, and cost remains insufficiently understood. We determined the in-hospital mortality and cost-driving factors of SE using a large and comprehensive database. Methods We conducted a retrospective cohort study involving patients experiencing their first hospitalization with an ICD-10 code diagnosis of SE, spanning from January 1, 2015, to December 31, 2019, using the French health insurance database which covers 99% of population. Patient characteristics, SE causes, Intensive Care Unit (ICU) admissions, mechanical ventilation, discharge status, and health insurance costs were extracted for each hospitalization. Results We identified 52,487 patients hospitalized for a first SE. In-hospital mortality occurred in 11,464 patients (21.8%), with associated factors including age (Odds Ratio [OR], 10.3, 95% Confidence Interval [CI] 7.87–13.8 for ages over 80 compared to 10–19), acute causes (OR, 15.3, 95% CI 13.9–16.8 for hypoxic cause), tumors (OR, 1.75, 95% CI 1.63–1.8), comorbidities (OR, 3.00, 95% CI 2.79–3.24 for 3 or more comorbidities compared to 0), and prolonged mechanical ventilation (OR, 2.61, 95% CI 2.42–2.82). The median reimbursed cost for each SE hospitalization was 6517€ (3364–13,354), with cost factors mirroring those of in-hospital mortality. Conclusion Causes and co-morbidities are major determinants of mortality and hospital costs in status epilepticus, and factors associated with higher mortality are also often associated with higher costs. Further studies are needed to identify their long-term effects.