Dizziness at a Canadian tertiary care hospital: A cost-of-illness study

Abstract

BackgroundIn the Canadian health care system, determining overall costs associated with a particular diagnostic subgroup of patients, in this case dizzy patients, is the first step in the process of determining where costs could be saved without compromising patient care. This study is the first Canadian study that evaluates these costs at a tertiary care hospital and will allow for the extrapolation of cost data for other similar academic health science centers, regional health initiatives, and provincial healthcare planning structures.MethodsWe conducted a retrospective cohort study of patients of any age presenting to The Ottawa Hospital (TOH), a tertiary care hospital, between January 1st, 2009 and December 31st, 2014 with a main diagnosis of dizziness or dizziness-related disease.De-identified patient information was acquired through TOH Data Warehouse and included a patient’s sex, age, arrival and departure dates, Elixhauser co-morbidity score, location of presentation (emergency department or admitted inpatient) presenting complaint, final diagnosis code, any procedure codes linked to their care, and the direct and indirect hospital costs linked with any admission.We derived the mean hospital costs and 95% confidence interval for each diagnosis. We obtained the number of patients who were diagnosed with dizziness within Ontario in year 2015–16 from Canadian Institute for Health Information (CIHI). A simple frequency multiplication was performed to estimate the total cost burden for Ontario based on the cost estimate for the same year obtained from TOH. Cost data were presented in 2017 Canadian dollars.ResultsThe average total hospital cost per patient with dizziness for the entire cohort is $450 (SD = $1334), with ED only patients costing $359 (SD = $214). The total estimated hospital cost burden of dizziness in Ontario is $31,202,000 (95% CI $29,559,000 – 32,844,000).ConclusionsThe estimated annual costs of emergency department ambulatory and inpatient dizziness in Ontario was calculated to be approximately 31 million dollars per year. This is the first step in identifying potential areas for cost savings to aid local and provincial policy-makers in allocation of health care spending.

Telling friend from foe in emergency vertigo and dizziness: does season and daytime of presentation help in the differential diagnosis?

“…Importantly, the frequency of VD in the ER and the large proportion of serious causes (stroke/TIA) stress the importance of thorough training routines for neurologists and otolaryngologists working in the ER. Recent work in a Canadian cohort showed that there are major training deficits in final year otolaryngologists with regard to vertigo diagnostic testing, more specifically the bedside head impulse test [16,19]. A survey-based study emphasized interdisciplinary differences between otolaryngologists and non-otolaryngologists with regard to vertigo diagnosis and treatment practices [24].…”

“…VD is responsible for major costs within both the emergency department and the inpatient setting [16]. Resource use has been found to be disproportionally high for ER patients with VD symptoms, especially with regard to diagnostic imaging [24].…”

Characteristics and resource needs in patients with vestibular symptoms: a comparison of patients with symptoms of unknown versus determined origin

“…Patients with vestibular symptoms are frequently seen in the ED and evaluation has to take into account common, potentially dangerous aetiologies such as strokes [2,4]. Various studies have investigated ED resource consumption by patients with certain vestibular diagnoses and reported frequent use of imaging [8][9][10][11]. However, to our knowledge, resource consumption by patients with VUO has not yet been investigated.…”

“…Despite those high costs that reflect extensive diagnostic testing, i.e. use of imaging, many patients with vestibular symptoms are discharged without a diagnosis explaining their symptoms [8][9][10][11]. We hypothesize that patients in whom the cause of vestibular symptoms could be determined would have a lower average ED resource consumption than patients with vestibular symptoms of unknown origin (VUO).…”

The Economic Burden of Vertigo: Results From the Hospitalized and Outpatients

“…Moreover, it was also stated that the mean total cost per patient was $450 ± $1333.68, but with inpatients only (n = 93) was $6978.94 ± $9991.16 in same study. 11 In addition, Benecke et al concluded that health-care utilization is increasing by disease severity and advanced age, according to the Registry to Evaluate the Burden of Disease in Vertigo (REVERT) data. 7 Lai et al also stated vertigo as a major health burden in particularly older women.…”