Economic Disparity in Functional Neurological Disorder: Rising Healthcare Costs, Low Research Investment
Christopher Stephen1, Vicki Fung2, David Perez1, Alberto Espay3
1Department of Neurology, 2Health Policy Research Center, Mongan Institute, Massachusetts General Hospital and Harvard Medical School, 3Department of Neurology, University of Cincinnati
Objective:
To assess U.S. inpatient and emergency department (ED) charges for functional neurological disorder (FND), investigate subtype variations, and compare costs relative to research funding across major neurological diagnoses.
Background:
FND have high costs and healthcare utilization comparable with investigation and pharmacologically-intensive neurological disorders. There is no data regarding variation of costs within FND subtypes, or comparison with federal research funding.
Design/Methods:
We used 2008-2019 Healthcare Cost and Utilization Project data to assess all-payer adult (≥18 years) and pediatric (5-17 years) inpatient and ED stays, and associated charges in 2019 inflation-adjusted US dollars, for ICD-10-defined FND (F.44.4-F44.7) versus neurological comparators neuro-inflammatory/demyelinating diseases, refractory epilepsy, and anterior horn cell diseases. Extramural NIH research funding from 2017-2023 was assessed using NIHRePORTER.
Results:
2019 calendar year charges (95% confidence interval) were assessed. Adult FND inpatient charges were $1,614.1 million ($1,492.8-1,735.4 million), increasing 47% since 2017, higher than neurological comparator groups. Pediatric FND inpatient charges were $105.7 million ($83.5-127.8 million), increasing 37% since 2012, lower than comparator groups. Adult FND ED charges were $257.9 million ($230.1-285.8 million), increasing 67% since 2017, exceeding all comparator groups except refractory epilepsy. Pediatric FND ED charges were $257.9 million ($230.1-285.8 million), increasing 108%, greater than comparator groups. Functional seizures accounted for most FND costs, given greater admission/presentation volume, while motor and mixed FND had the highest per-patient costs. Total 2019 inpatient and ED charges for adult and pediatric FND were $2.0 billion, increasing 49% since 2017. The relative proportion of NIH funding to total inpatient and ED charges was lowest in FND versus all neurological comparators.
Conclusions:
There is unabated increase in the prevalence and annual costs of inpatient and ED FND care for adults and children, exceeding $2 billion in 2019. These costs surpass those of similarly complex neurological conditions, yet FND receives limited research funding relative to these healthcare costs.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.