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Andrew C. Vivas, Ali A. Baaj, Selim R. Benbadis and Fernando L. Vale

Object

The aim of this study was to analyze the national health care burden of patients diagnosed with epilepsy in the US and to analyze any changes in the length of stay, mean charges, in-hospital deaths (mortality), and disposition at discharge.

Methods

A retrospective review of the Nationwide Inpatient Sample (NIS) database for epilepsy admissions was completed for the years from 1993 to 2008. The NIS is maintained by the Agency for Healthcare Research and Quality and represents a 20% random stratified sample of all discharges from nonfederal hospitals within the US. Patients with epilepsy were identified using ICD-9 codes beginning with 345.XX. Approximately 1.1 million hospital admissions were identified over a span of 15 years.

Results

Over this 15-year period (between 1993 and 2008), the average hospital charge per admission for patients with epilepsy has increased significantly (p < 0.001) from $10,050 to $23,909, an increase of 137.9%. This is in spite of a 33% decrease in average length of stay from 5.9 days to 3.9 days. There has been a decrease in the percentage of in-hospital deaths by 57.9% and an increase in discharge to outside medical institutions.

Conclusions

The total national charges associated with epilepsy in 2008 were in excess of $2.7 billion (US dollars, normalized). During the studied period, the cost per day for patients rose from $1703.39 to $6130.51. In spite of this drastic increase in health care cost to the patient, medical and surgical treatment for epilepsy has not changed significantly, and epilepsy remains a major source of morbidity.

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Dzenan Lulic, Amir Ahmadian, Ali A. Baaj, Selim R. Benbadis and Fernando L. Vale

Vagus nerve stimulation (VNS) is a key tool in the treatment of patients with medically refractory epilepsy. Although the mechanism of action of VNS remains poorly understood, this modality is now the most widely used nonpharmacological treatment for drug-resistant epilepsy. The goal of this work is to review the history of VNS and provide information on recent advances and applications of this technology.

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Ali A. Baaj, Selim R. Benbadis, William O. Tatum and Fernando L. Vale

Object

Vagus nerve stimulation (VNS) plays a significant role in the treatment of intractable epilepsy. The goal of this study was to analyze trends in the use of VNS for epilepsy in the US by using a nationwide database.

Methods

Data for patients undergoing VNS were obtained from the nationwide inpatient sample for the years 1998–2005. Trends regarding number of procedures, length of stay (LOS), hospital charges, patient sex, and payer information were retrieved and analyzed.

Results

The number of VNS procedures for epilepsy increased between 1998 and 2003 but decreased in the subsequent 2 years. The LOS and hospital charges showed yearly increases. Female patients underwent VNS implantation more than males did, and most procedures were performed in the 18- to 64-year-old age group. The combination of Medicare and Medicaid provided most of the funding for VNS from 2002 through 2005. The VNS procedures were performed mostly in teaching hospitals.

Conclusions

Trends from a national database reveal consistent use of VNS for intractable epilepsy. Greater use of the procedure appears to be reflected in the female population, and the procedure has been performed most often at tertiary care teaching hospitals, where a comprehensive evaluation for all forms of therapy is arguably best able to target appropriate patients for appropriate therapies. With the recent application of VNS to target populations without epilepsy, such as patients with refractory depression, the trend of continued use of this treatment for epilepsy appears likely.