Neurology Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
Neurology Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.
Mult Scler Relat Disord. 2019 Oct;35:104-107. doi: 10.1016/j.msard.2019.07.013. Epub 2019 Jul 20.
Tumefactive demyelinating lesions occur as part of the spectrum of multiple sclerosis (MS), but can be difficult to distinguish from other large cerebral lesions such as neoplasm or abscess.
To estimate the cost associated with diagnostic investigation of patients with tumefactive demyelination (TD), including associated morbidity, and compare this to more typical relapsing-remitting MS.
Retrospective review of medical records of patients seen between 2013 and 2018 in clinics at the Brain and Mind Centre, Sydney, Australia; a center with tertiary referral expertise in MS.
Thirty-one patients with TD and 31 patients with MS were compared. The cost of investigating TD was more than 7.5 times higher per patient than MS ($18,300 vs $2418, p < 0.01). More patients in the TD group were admitted to hospital (22/31 versus 10/31) and ICU admissions only occurred in the TD group (10/22 versus 0/10). Brain biopsy was performed only in the TD group (7 patients), which contributed to cost differences and also accounted for differences in adverse outcomes.
The cost and morbidity related to investigating TD is higher than in typical MS. Improvements in the diagnosis of TD have the potential to improve health and economic outcomes.
肿块样脱髓鞘病变是多发性硬化症（MS）谱的一部分，但与其他大型大脑病变（如肿瘤或脓肿）难以区分。
估计诊断肿块样脱髓鞘病变（TD）患者相关的调查费用，包括相关发病率，并与更典型的复发缓解型 MS 进行比较。
回顾性分析 2013 年至 2018 年间澳大利亚悉尼脑与心智中心诊所就诊的 31 例 TD 患者和 31 例 MS 患者的病历；该中心在 MS 方面具有三级转诊专业知识。
31 例 TD 患者和 31 例 MS 患者进行了比较。每位 TD 患者的调查费用比 MS 高 7.5 倍以上（$18,300 比 $2418，p<0.01）。TD 组更多患者住院（22/31 比 10/31），仅 TD 组患者入住 ICU（10/22 比 0/10）。仅在 TD 组进行了脑活检（7 例），这导致了费用差异，也导致了不良结局的差异。
诊断 TD 相关的成本和发病率高于典型 MS。提高 TD 的诊断水平有可能改善健康和经济结局。
