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Krankheitskosten und Outcome: Versorgungsrealität des Status epilepticus

Cost of illness and outcome of status epilepticus in Germany

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Zusammenfassung

Hintergrund

In einem zunehmend ökonomisch ausgerichteten Gesundheitssystem gewinnt die Erfassung, Aufarbeitung und Analyse von krankheitsspezifischen Kosten zunehmend an Relevanz. Insbesondere chronische Erkrankungen wie die Epilepsie stehen hierbei aufgrund hoher direkter und indirekter Krankheitskosten im Fokus des Interesses. Der Status epilepticus (SE) ist eine lebensbedrohliche und akut behandlungsbedürftige Entität, welche zusätzliche Kosten generiert, die in den meisten Krankheitskostenstudien nicht adäquat berücksichtigt werden.

Fragestellung

Die systematische Aufarbeitung krankheitsspezifischer Kosten sowie der Mortalität des SE im nationalen und internationalen Vergleich.

Material und Methode

Es erfolgte eine kombinierte systematische Literaturrecherche in elektronischen Datenbanken via PubMed-Gateway im Juni 2018.

Ergebnisse

Es konnten drei Krankheitskostenstudien zu SE in Deutschland identifiziert werden. Die medianen direkten Kosten betrugen bei einer mittleren Verweildauer von ca. 1 bis 2 Wochen ca. 4000–15.000 € pro Aufenthalt. Die Krankenhausmortalität betrug ca. 10–15 %. Hierbei fielen für Patienten mit nicht refraktärem SE (NSE) im Mittel Kosten von 4500–5500 € an (Mortalität 10 %, Verweildauer 8 Tage), für refraktäre SE (RSE) Aufwendungen von 4500–13.500 € (Mortalität 15 %, Verweildauer 14 Tage) und für super-RSE (SRSE) Ausgaben in Höhe von 33.000–50.500 € (Mortalität 40 %, Verweildauer 37 Tage). Diese Ergebnisse sind analog zu anderen Krankheitskostenstudien aus Australien, Indien und den USA.

Schlussfolgerung

Der SE stellt sowohl aus gesundheitsökonomischen als auch aus versorgungsmedizinischen Aspekten eine relevante Krankheitsmanifestation dar. Weitere Studien zur Erfassung von Inzidenz, Mortalität und Kosten werden insbesondere in Anbetracht der wachsenden Anzahl an Behandlungsoptionen dringend benötigt.

Abstract

Background

In times of an increasing economic impact on healthcare systems the collection, processing and analysis of disease-specific costs becomes more and more relevant. This is particularly true for chronic diseases, such as epilepsy where the focus of interest is due to the high direct and indirect costs of the disease. The additional economic impact of status epilepticus (SE) is under-represented in the few available cost of illness studies (COI).

Objective

The systematic analysis and comparison of disease-specific costs and mortality of SE in Germany and other countries.

Methods

A systematic combined literature search was performed via the PubMed gateway in June 2018.

Results

A total number of three COI studies was available on SE in Germany. The median direct costs amounted to ca. 4000–15,000 € per stay with a mean length of stay (LOS) of 1–2 weeks. The inhospital mortality was 10–15%. For patients with non-refractory SE (NSE) average costs were calculated as 4500–5500 € (mortality 10%, LOS 8 days), whereas refractory SE (RSE) accounted for 4500–13,500 € (mortality 15%, LOS 14 days) and super-RSE (SRSE) 33,000–50,500 € (mortality 40%, LOS 37 days). These results are comparable to other COI studies on SE from Australia, India and the USA.

Conclusion

From both health-economic and healthcare perspectives SE represents a relevant disease manifestation. Further studies to collate the incidence, mortality and costs are urgently needed in view of the increasing number of treatment options.

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Authors and Affiliations

  1. Epilepsiezentrum Frankfurt Rhein-Main und Klinik für Neurologie, Goethe-Universität Frankfurt, 60528, Frankfurt am Main, Deutschland

    Laurent M. Willems MHBA, Lara Kay, Felix Rosenow & Adam Strzelczyk

  2. LOEWE Schwerpunkt „Center for Personalized Translational Epilepsy Research“ (CePTER), Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland

    Laurent M. Willems MHBA, Lara Kay, Felix Rosenow & Adam Strzelczyk

  3. Epilepsiezentrum Hessen und Klinik für Neurologie, Philipps-Universität Marburg, Marburg (Lahn), Deutschland

    Felix Rosenow & Adam Strzelczyk

Authors
  1. Laurent M. Willems MHBA
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  2. Lara Kay
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  3. Felix Rosenow
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  4. Adam Strzelczyk
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Corresponding author

Correspondence to Laurent M. Willems MHBA.

Ethics declarations

Interessenkonflikt

L. Kay berichtet über Reisekostenerstattung von Eisai und UCB Pharma. F. Rosenow berichtet über Honorare und Forschungsförderung durch von Eisai, Desitin Arzneimittel, Novartis, Medtronic, Cerbomed, ViroPharma, Sandoz, Bayer Vital und Shire sowie Forschungsförderung durch die Europäische Union und die Deutsche Forschungsgemeinschaft. A. Strzelczyk berichtet über Honorare und Forschungsförderung durch Desitin Arzneimittel, Eisai, LivaNova, Sage Therapeutics, UCB Pharma und Zogenix. L.M. Willems gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Laurent M. Willems und Lara Kay haben zu gleichen Teilen beigetragen.

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Willems, L.M., Kay, L., Rosenow, F. et al. Krankheitskosten und Outcome: Versorgungsrealität des Status epilepticus. Z. Epileptol. 31, 267–271 (2018). https://doi.org/10.1007/s10309-018-0205-y

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