Jeong Seth S, Simpson Kit N, Johnson Jada M, Rizk Habib G
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Medical University of South Carolina, Charleston.
Albert Einstein College of Medicine, Bronx, New York.
JAMA Otolaryngol Head Neck Surg. 2022 Oct 13;148(12):1103-10. doi: 10.1001/jamaoto.2022.3247.
Understanding of the economic burden of recurrent vestibular causes of vertigo and areas contributing to the cost is needed.
To analyze and identify the factors contributing to the direct medical costs associated with Ménière disease (MD), vestibular migraine (VM), and benign paroxysmal positional vertigo (BPPV).
DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation used MarketScan Commercial Database claims data from 2018 to identify the non-Medicare patient population with the diagnoses of MD, VM, or BPPV. Data were analyzed January 1 to December 31, 2018.
The total direct medical costs associated with MD, VM, and BPPV.
A total of 53 210 patients (mean [SD] age, 47.8 [11.8] years; 67.6% female) were included in this study, with 34 738 normal comparisons. There were 5783 (10.9%) patients with MD, 3526 (6.6%) patients with VM, and 43 901 (82.5%) patients with BPPV in the data set. Mean age and sex were different across the different vestibular disorders. Across the different groups, patients with no comorbidities or with a Charlson Comorbidity Index score of zero ranged from 98.4% to 98.8%. Around 5% of patients were hospitalized with inpatient stay lasting between 4.6 and 5.2 days. After adjusting for age, sex, and comorbidities, there were large differences in mean adjusted annual payments/direct costs across the different groups (MD, $9579; VM, $11 371; and BPPV, $8247). This equated to a total incremental estimated cost of $60 billion compared with the normal population. The number of outpatient brain magnetic resonance imaging or computed tomography scans per patient ranged anywhere from 1 to 20, while the number of inpatient brain magnetic resonance imaging or computed tomography scans per patient ranged anywhere from 1 to 6. A heat map of the total cost expenditure indicated that the costs were concentrated around the Midwest, Lake Michigan, and the East Coast.
In this economic evaluation, the 3 most common causes of recurrent vertigo-MD, VM, and BPPV-had considerable medical costs associated with them. Extraneous imaging orders and vestibular testing are factors to consider for cost reduction. However, further research and widespread education is needed to optimize the diagnosis, treatment, and care of patients presenting with vestibular disorders or dizziness.
需要了解复发性前庭性眩晕的经济负担以及导致成本的因素。
分析并确定与梅尼埃病（MD）、前庭性偏头痛（VM）和良性阵发性位置性眩晕（BPPV）相关的直接医疗费用的影响因素。
设计、设置和参与者：这项经济评估使用了2018年MarketScan商业数据库的索赔数据，以识别诊断为MD、VM或BPPV的非医疗保险患者群体。数据于2018年1月1日至12月31日进行分析。
与MD、VM和BPPV相关的总直接医疗费用。
本研究共纳入53210名患者（平均[标准差]年龄为47.8[11.8]岁；67.6%为女性），另有34738名作为正常对照。数据集中有5783名（10.9%）MD患者、3526名（6.6%）VM患者和43901名（82.5%）BPPV患者。不同前庭疾病患者的平均年龄和性别存在差异。在不同组中，无合并症或Charlson合并症指数评分为零的患者比例在98.4%至98.8%之间。约5%的患者住院，住院时间在4.6至5.2天之间。在对年龄、性别和合并症进行调整后，不同组之间的平均调整后年度支付/直接成本存在很大差异（MD为9579美元；VM为11371美元；BPPV为8247美元）。与正常人群相比，这相当于总计约600亿美元的增量估计成本。每位患者的门诊脑磁共振成像或计算机断层扫描次数从1次到20次不等，而每位患者的住院脑磁共振成像或计算机断层扫描次数从1次到6次不等。总成本支出的热图显示，成本集中在中西部、密歇根湖和东海岸地区。
在这项经济评估中，复发性眩晕的3种最常见病因——MD、VM和BPPV——都伴有相当高的医疗费用。不必要的影像学检查和前庭测试是降低成本时需要考虑的因素。然而，需要进一步研究并广泛开展教育，以优化前庭疾病或头晕患者的诊断、治疗和护理。
