From the Johns Hopkins Encephalitis Center (J.C., S.G., E.G.-L., R.G.G., J.C.P., A.V.), Department of Neurology, and Departments of Neurosurgery and Anaesthesia/Critical Care (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Neurology Department (J.S.), IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology and Pediatrics (A.K.Y.), Icahn School of Medicine at Mt. Sinai, New York, NY; Department of Neurology and Developmental Medicine (E.G.-L.), Kennedy Krieger Institute; and Johns Hopkins Carey Business School (K.D.F.), Baltimore MD.
Neurology. 2019 Feb 26;92(9):e964-e972. doi: 10.1212/WNL.0000000000006990. Epub 2019 Jan 23.
To assess the inpatient hospitalization burden and costs of patients with autoimmune encephalitis (AE) at a tertiary care institution.
Adult inpatients with AE were identified retrospectively from July 1, 2005, to June 30, 2015. Demographic and clinical data were collected and analyzed. Billing data were compared to those of patients with herpes simplex encephalitis (HSE). Charges were adjusted for inflation.
Of 244 admissions for encephalitis reviewed, 63 patients met criteria for probable or definite AE. Thirty-one (49%) patients were antibody positive, and 27 (43%) were admitted to the intensive care unit (ICU). Median hospital charges per patient with AE were more than $70,000; median length of stay (LOS) was 15 days; and in-hospital mortality was 6%. Patients admitted to the ICU had substantially higher median hospital charges (ICU $173,000 per admission vs non-ICU $50,000 per admission, < 0.001). LOS was strongly associated with charges and was driven by delay in diagnosis of AE, prolonged treatment courses, and lack of response to therapy. Compared with HSE, median hospital charges per patient with AE were nearly 4 times higher, median AE LOS was 3 times higher, and total charges over the study period were nearly twice as high.
Patients with AE used more inpatient health care resources per patient during a 10-year period than patients with HSE at our institution. ICU-admitted patients with AE were responsible for a substantially higher financial burden than non-ICU-admitted patients with AE. Our data underscore the need for the development of novel diagnostic and therapeutic modalities to improve patient outcomes and to decrease hospital burden in AE.
评估一家三级保健机构自身免疫性脑炎 (AE) 患者的住院负担和费用。
回顾性地从 2005 年 7 月 1 日至 2015 年 6 月 30 日，在一家三级保健机构识别出患有 AE 的成年住院患者。收集并分析了人口统计学和临床数据。与单纯疱疹脑炎 (HSE) 患者进行计费数据比较。对费用进行了通货膨胀调整。
在审查的 244 例脑炎住院中，有 63 例符合可能或明确 AE 的标准。31 例（49%）患者抗体阳性，27 例（43%）患者入住重症监护病房 (ICU)。AE 患者的人均住院费用超过 70000 美元；中位数住院时间（LOS）为 15 天；住院死亡率为 6%。入住 ICU 的患者的人均住院费用显著较高（ICU 每例 173000 美元，非 ICU 每例 50000 美元，<0.001）。LOS 与费用密切相关，主要是由于 AE 的诊断延迟、治疗过程延长以及对治疗反应不佳所致。与 HSE 相比，AE 患者的人均住院费用几乎高出 4 倍，AE 的中位 LOS 高出 3 倍，研究期间的总费用几乎高出 2 倍。
在 10 年期间，与本机构的 HSE 患者相比，AE 患者的每位患者使用的住院医疗资源更多。与非 ICU 入住 AE 患者相比，入住 ICU 的 AE 患者的经济负担要大得多。我们的数据强调需要开发新的诊断和治疗方法，以改善患者的预后并减轻 AE 的住院负担。
