Prospective, Population-Based Evaluation of Costs and Outcomes of Status Epilepticus According to the New Definition

Abstract

Background

To address the paucity of data on outcomes and costs of status epilepticus (SE) following the updated 2015 International League Against Epilepsy (ILAE) definition and changes in clinical practice guidelines in Germany.

Methods

This prospective population-based study (October 2018–March 2020) included adult patients from postal code area prefix 35, representative of Germany, diagnosed with SE according to the 2015 ILAE definition. Costs were calculated using German Diagnosis-Related Groups (G-DRG).

Results

In total, 181 patients were included. Mean inpatient costs were €10,543 (median €6376; range €845–€133,267), corresponding to €939 per hospital day (median €580.8; range €76.8–€12,115). Mean length of stay (LOS) was 11 days (median 9; range 1–67). In univariable analyses, super-refractory SE was associated with higher costs and longer LOS (both p < 0.001), while acute symptomatic etiology was associated with longer LOS (p = 0.006). On multivariable analysis, mechanical ventilation was the strongest independent predictor of costs (Exp(B) = 2.918, 95% CI 1.753–4.857; p < 0.001), and etiology was overall significantly associated with cost variation (p = 0.022), with acute symptomatic SE showing the highest adjusted costs. Discharge destination correlated with SE severity, with most patients with non-refractory SE discharged home (p = 0.028).

Conclusions

This study provides population-based data on costs and outcomes of SE in Germany, serving as a basis for future cost-effectiveness analyses. Compared with earlier studies, lower direct costs and shorter LOS were observed. Identification of high-risk constellations may support clinical decision-making and optimize monitoring, treatment escalation, and allocation of intensive care resources.