Heterogeneous Cost Patterns of Episodic Recurrent Vestibular Vertigo in the Medicare Population: A Case-Control Economic Evaluation.

Abstract

ObjectiveTo evaluate Medicare costs and healthcare usage with total annual payments comprising hospital, outpatient and prescription costs, neuroimaging, and vestibular and audiometric testing for benign paroxysmal vertigo (BPPV), Ménière's Disease (MD), and Vestibular Migraine (VM).MethodsA case-control economic evaluation was conducted using 2018 MarketScan Medicare Database claims. Cohorts included BPPV, MD, and VM Medicare patients matched to controls without dizziness diagnoses by age, sex, state, and Charlson Comorbidity Index. Twelve-month direct medical costs were analyzed.Results6049 BPPV patients compared to 6049 controls, 1665 MD patients compared to 3307 controls, and 227 VM patients compared to 451 controls were included. Mean age was similar across groups and ranged from 72.3 $\pm$ 6.3 (VM) to 74.4$\pm$ 7.2 (BPPV), with most patients being female, especially among VM patients (n=171; 75.3%). Most patients and controls (51.9% BPPV, 61.1% MD, 58.6% VM) had no comorbidities (CCI score = 0). Inpatient visits were only significantly higher in VM Medicare patients compared to controls (30.0% vs 11.5%; p<0.0001). Total adjusted payments were 20% lower for BPPV and MD patients (p<0.0001), but 31% higher for VM (p=0.0025) patients compared to controls, amounting to an incremental increase in cost of $6036 per person per year. Inpatient and outpatient neuroimaging was more common among all vestibular disorder groups compared to controls. Healthcare costs of the vertigo disorders were twice as high in Medicare populations compared to non-Medicare counterparts.ConclusionHeterogenous Medicare cost patterns were found among the three most common episodic vertigo causes that deviate from the expected pattern in younger counterparts. Medicare VM patients had higher costs than non-VM counterparts while BPPV and MD patients had lower costs with respective controls. Better hands-on education regarding vestibular disorders for "frontline" medical personnel may improve underdiagnosis or misdiagnosis and reduce excessive investigations, creating opportunities for economic burden reduction.