Autoimmune encephalitis A costly condition
Autoimmune encephalitis A costly condition
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DOI：
10.1212/wnl.0000000000006990
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发表时间：
2019-02-26
期刊：
影响因子：
9.9
通讯作者：
Venkatesan, Arun
中科院分区：
文献类型：
--
作者：
Cohen, Jesse;Sotoca, Javier;Venkatesan, Arun
目的评估三级医疗机构自身免疫性脑炎（AE）患者的住院负担和费用。方法回顾性分析2005年7月1日至2015年6月30日期间AE成人住院患者。收集并分析人口统计学和临床数据。将账单数据与单纯疱疹病毒性脑炎（HSE）患者的数据进行比较。收费调整inflation.ResultsOf 244入院脑炎审查，63例符合标准的可能或明确的AE。31例（49%）患者抗体阳性，27例（43%）患者入住重症监护室（ICU）。每位AE患者的平均住院费用超过70，000美元;平均住院时间（LOS）为15天;住院死亡率为6%。入住ICU的患者的平均住院费用明显更高（ICU每次入院173，000美元vs非ICU每次入院50，000美元，p < 0.001）。LOS与费用密切相关，并由AE诊断延迟、疗程延长和治疗无应答驱动。与HSE相比，每位患者的平均住院费用高出近4倍，平均AE LOS高出3倍，在研究期间的总费用近两倍high.ConclusionsPatients与AE使用更多的住院医疗资源，每位患者在10年期间比HSE患者在我们的机构。ICU收治的AE患者的经济负担显著高于非ICU收治的AE患者。我们的数据强调需要开发新的诊断和治疗方式，以改善患者的预后，减少AE的医院负担。
ObjectiveTo assess the inpatient hospitalization burden and costs of patients with autoimmune encephalitis (AE) at a tertiary care institution.MethodsAdult inpatients with AE were identified retrospectively from July 1, 2005, to June 30, 2015. Demographic and clinical data were collected and analyzed. Billing data were compared to those of patients with herpes simplex encephalitis (HSE). Charges were adjusted for inflation.ResultsOf 244 admissions for encephalitis reviewed, 63 patients met criteria for probable or definite AE. Thirty-one (49%) patients were antibody positive, and 27 (43%) were admitted to the intensive care unit (ICU). Median hospital charges per patient with AE were more than $70,000; median length of stay (LOS) was 15 days; and in-hospital mortality was 6%. Patients admitted to the ICU had substantially higher median hospital charges (ICU $173,000 per admission vs non-ICU $50,000 per admission, p < 0.001). LOS was strongly associated with charges and was driven by delay in diagnosis of AE, prolonged treatment courses, and lack of response to therapy. Compared with HSE, median hospital charges per patient with AE were nearly 4 times higher, median AE LOS was 3 times higher, and total charges over the study period were nearly twice as high.ConclusionsPatients with AE used more inpatient health care resources per patient during a 10-year period than patients with HSE at our institution. ICU-admitted patients with AE were responsible for a substantially higher financial burden than non-ICU-admitted patients with AE. Our data underscore the need for the development of novel diagnostic and therapeutic modalities to improve patient outcomes and to decrease hospital burden in AE.