Continuous versus routine EEG in critically ill adults: reimbursement analysis of a randomised trial

Abstract

BACKGROUND: Continuous EEG (cEEG) is increasingly used in critically ill patients, but it is more resource-intensive than routine EEG (rEEG). In the US, cEEG generates increased hospitalisation charges. This study analysed hospital-related reimbursement for participants in a Swiss multicentre randomised controlled trial that assessed the relationship of cEEG versus repeated rEEG with outcome. METHODS:We used data of the CERTA study (NCT03129438), including demographics, clinical variables and reimbursement for acute hospitalisations after the Swiss Diagnosis Related Groups billing system. In addition to a comparison between EEG intervention groups, we explored correlations with several clinical variables, using uni-and multivariate analyses. RESULTS: In total, 366 adults were analysed (184 cEEG, 182 rEEG); 123 (33.6%) were women, mean age was 63.8 years (± 15). Median hospitalisation reimbursement was comparable across EEG groups in univariate analysis: cEEG CHF 89,631 (interquartile range [IQR] 45,635-159,994); rEEG CHF 73,017 (IQR 43,565); p = 0.432. However, multivariate regression disclosed that increasing reimbursement mostly correlated with longer acute hospitalisation (p <0.001), but also with cEEG (p = 0.019) and lack of seizure / status epilepticus detection (a surrogate of survival, p = 0.036).CONCLUSION: In a Swiss Diagnosis Related Groups billing system applied to critically ill adults, reimbursement largely depends on duration of acute hospital stay, whereas cEEG and lack of seizure/ status epilepticus detection also contribute to the bill. This differs from the USA, where charges are directly increased by cEEG.

Continuous versus Routine Electroencephalography in the Intensive Care Unit: A Review of Current Evidence

“…Further analysis of the CERTA dataset shed an interesting and partly new light regarding the role of cEEG versus rEEG in ICU patients, beyond the aforementioned outcomes. Of relevance, in a diagnosis-related group reimbursement system (which is common to many European countries, but also beyond) cEEG does not significantly generate more costs [ 68 ], unlike in the USA [ 5 ], and thus does not represent any financial incentive. Considering prognostic EEG features, cEEG allows, in comparison to rEEG, a significant increased detection not only of ictal events but also of generalized rhythmic delta [ 69 ] and sleep spindles [ 70 ], which are both related to favorable prognosis.…”

Utility and rationale for continuous EEG monitoring: a primer for the general intensivist

“…Continuous EEG (cEEG) monitoring is paramount in critically ill patients, offering superior sensitivity over routine or intermittent EEG, which typically entails brief recordings lasting 20–40 min [ 53 – 55 ]. Studies suggest that while brief EEG can be cost-effective and comparable in seizure detection rates as cEEG in certain contexts like post-cardiac arrest patients [ 56 , 57 ], the prolonged duration of cEEG generally yields better prognostic accuracy for clinical outcome.…”

Continuous versus routine EEG in patients after cardiac arrest

“…13,14 Indeed, it has been demonstrated that cEEG proves more sensitive for seizure or SE detection than routine EEG (rEEG, typically lasting 20-30 minutes). 15,16 On the other hand, it is more time-, resource-and person-consuming, 11,[15][16][17] which may lead to questioning the costeffectiveness in some settings. 18 Therefore, large-scale cEEG implementation in many centers outside North America is still somewhat limited.…”