The real-world economic impact of home-based video electroencephalography: the payer perspective

Abstract

Aims: Electroencephalography (EEG) is an established method to evaluate and manage epilepsy; video EEG (VEEG) has significantly improved its diagnostic value. This study compared healthcare costs and diagnostic-related outcomes associated with outpatient vs inpatient VEEG among patients with epilepsy in the US. Materials and methods: This study used Truven MarketScan Commercial and Medicare Supplemental claims databases. Patients with a VEEG between July 1, 2013 and December 31, 2016 were identified. Index event was the first VEEG claim, which was used to determine inpatient and outpatient cohorts. Continuous health plan enrollment 6 months pre-and 12 months post-index VEEG was required. Primary outcomes were costs during the index event and 12 months post index. A generalized linear model with gamma distribution and a log link was used to estimate adjusted index and postindex costs. Results: Controlling for baseline differences, epilepsy-related cost of index VEEG was significantly lower for the outpatient ($4,098) vs the inpatient cohort ($13,821; p < 0.0001). The cost differences observed at index were maintained in the post-index period. The 12-month post-index epilepsy-related costs were lower in the outpatient cohort ($6,114 vs $12,733, p < 0.0001). Time from physician referral to index VEEG was significantly shorter in the outpatient cohort (30.6 vs 42.5 days). Patients in the inpatient cohort were also more likely to undergo an additional subsequent follow-up inpatient VEEG (p < 0.0001). Limitations: Administrative claims data have limitations, including lack of data on clinical presentation, disease severity, and comprehensive health plan information. Generalizability may be limited to a US insured population of patients who met study criteria. Conclusions: Index VEEG was less costly in an outpatient vs inpatient cohort, and costs were lower during the follow-up period of 12 months, suggesting that outpatient VEEG can be provided to appropriate patients as a less costly option. There were fewer follow-up tests in the outpatient cohort with similar pre-and post-index diagnoses.

How much time is enough? Establishing an optimal duration of recording for ambulatory video EEG

“…In‐home EEG has demonstrated equitable diagnostic outcomes compared to gold standard inpatient monitoring 16 at a significantly lower cost, 10 making diagnostic assessments more accessible to a wider range of patient populations. However, in‐home assessments are only effective if used appropriately.…”

“…8 Further, the natural environmental stressors of the patient's home may spur certain events that may not otherwise occur in an EMU setting. 7,9 Therefore, in-home vide EEG, when used effectively, offers a unique opportunity to reduce some of the burdens associated with costs and scheduling of inpatient assessments 10 and can support initiatives to improve access to diagnostic testing, specifically for the many epilepsy patients who live in rural regions or underserved communities. 11 With more flexibility in prescribing prolonged in-home EEG assessments, determining an optimal duration to observe typical, clinically relevant events is essential.…”

Past, Present and Future of Home video‐electroencephalographic telemetry: A review of the development of in‐home video‐electroencephalographic recordings

“…Patients who had undergone inpatient studies were found to be more likely to undergo subsequent additional inpatient testing, further contributing to an increase in long‐term costs. The same study also demonstrated that the time from physician referral to performance of the study was significantly shorter for HVET versus inpatient VT 13 . Due to an identical national tariff for inpatient VT and HVET in the UK National Health Service, the development of home recording was supported and found in the case of supervised recordings to be 30% cheaper than the inpatient recordings.…”

“…Equipment is light and flexible and can be used indoors and out. No daily visits by a technician are needed, and the recording is unsupervised of the study was significantly shorter for HVET versus inpatient VT. 13 Due to an identical national tariff for inpatient VT and HVET in the UK National Health Service, the development of home recording was supported and found in the case of supervised recordings to be 30% cheaper than the inpatient recordings. In addition, at King's College Hospital, three inpatient VT beds were no longer required, and were converted to neurosurgical beds, allowing an extra 460 elective surgical cases to be treated.…”

Ambulatory EEG: Crossing the divide during a pandemic

“…Electrical safety can be established by avoiding electrical current leakage through proper use of fuses, outlets to ground the equipment, grounding electrode, and by avoiding use of extension cords. 56 Patients should be advised to avoid contact of the electrical machinery and wiring with water to maximize safety and minimize electrical current exposure that has been linked to skin burns and potentially more serious injury. 56 …”