Higher Costs, Utilization Linked With Emergency Department Use Among Patients With Functional Neurological Diseases

According to new research published online in JAMA Neurology, patients with functional neurological disorders have increased health care use, including treatment costs that are comparable to those of care-intensive neurological disorders. 

A team of researchers sought to better understand emergency department (ED) and inpatient use and related charges for functional neurological disorders. According to the authors, limited data exists for health care use and costs among patients in this patient population.  

“This economic evaluation used Healthcare Cost and Utilization Project data to assess all-payer (1) adult (age, ≥18 years) hospitalizations (2008-2017), (2) pediatric (age, 5-17 years) hospitalizations (2003, 2006, 2009, 2012, and 2016), and (3) adult and pediatric ED evaluations (2008-2017),” the researchers wrote.  

They analyzed data from January 2019 through July 2020, focusing on hospital charges and admission traits such as, demographic characteristics of patients, length of stay, and discharge disposition.  

“Compared with other neurological disorders in 2017, emergency functional neurological disorder evaluations of 36,359 adults (25,807 women [71.0%] and 3800 children (2733 girls [71.9%]) more frequently resulted in inpatient admissions (22,895 adult admissions [69.2% female] and 1264 pediatric admissions [73.4%]),” they explained.

According to the findings, patients with functional neurological disorders who were admitted to an ED had a shorter mean hospital length of stay (5.21 [0.15] days vs 6.03 [0.03] days, P < .001). However, these patients experience higher workup rates compared to admissions for comparable neurological diagnoses. Further study findings show that functional neurological disorders were linked with lower rates of:

• inpatient physical therapy;
• occupational therapy;
• speech and language pathology; and
• psychiatric consultation.

The cost findings of the study showed that total annual costs (a proxy for total costs in 2017 US dollars) were $1066 million (95% CI, $971-$1160 million) for adult functional neurological disorder inpatient charges in 2017. This was compared with $1241 million (95% CI, $1132-$1351 million) for anterior horn cell disease. The study authors also found that total annual costs were $75 million (95% CI, $57-$92 million) for pediatric functional neurological disorder inpatient charges in 2012 compared with $86 million (95% CI, $63-$108 million) for demyelinating diseases. Finally, they found that total annual costs were $163 million (95% CI, $144-$182 million) for adult and pediatric ED visits in 2017 compared with $135 million (95% CI $111-$159 million) for refractory epilepsy. 

Overall, the findings showed that the total charges per admission for the ED care of functional neurological disorders were higher than the other comparison groups in adults, and total costs and costs per admission for this patient population from 2008 to 2017 increased at a higher rate compared to other neurological diseases.  

“This economic evaluation found that the more than $1.2 billion and increasing annual costs for ED and inpatient care of functional neurological disorders were similar to other investigation-intensive and pharmacologically demanding neurological disorders,” the study authors concluded. 

“Unnecessary investigations and iatrogenic harm inflate costs at the expense of necessary but neglected psychiatric and rehabilitative treatments.” —Julie Gould