How much does it cost to identify a critically ill child experiencing electrographic seizures?
Nicholas S Abend1, Alexis A Topjian, Sankey Williams
1Departments of *Neurology, †Pediatrics, and ‡Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.; §Department of Medicine, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.; and ‖Department of Health Care Management, Wharton School of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
Continuous electroencephalogram (EEG) monitoring for 24 hours is a cost-effective strategy for identifying electrographic seizures in critically ill children. While longer monitoring periods increase costs, 24-hour EEG offers a modest cost per identified seizure.
Area of Science:
- Pediatric Critical Care Medicine
- Neurophysiology
- Health Economics
Background:
- Continuous electroencephalogram (EEG) monitoring is crucial for detecting electrographic seizures in critically ill children.
- The optimal duration and cost-effectiveness of EEG monitoring strategies remain subjects of investigation.
Purpose of the Study:
- To evaluate the cost-effectiveness of four electrographic seizure identification strategies in critically ill children.
- Strategies included no EEG monitoring and EEG monitoring for 1, 24, or 48 hours.
Main Methods:
- A decision tree model was developed from a societal perspective.
- Variable costs of EEG monitoring were estimated, and outcome probabilities were derived from literature review.
- Incremental cost-effectiveness ratios were calculated to assess cost-benefit trade-offs.
Main Results:
- EEG monitoring for 24 hours was identified as a preferred strategy within a willingness-to-pay range of $1,666-$22,648 per identified seizure.
- The 48-hour strategy yielded only a 4% increase in seizure identification at a significantly higher cost.
- Sensitivity analyses indicated that 1, 24, and 48-hour strategies were acceptable at lower willingness-to-pay thresholds for high-risk pediatric patients.
Conclusions:
- Monitoring critically ill children for 24 hours is supported due to its modest cost per identified electrographic seizure.
- Further research is necessary to identify specific pediatric subgroups that may benefit from 48-hour EEG monitoring, given its substantially higher costs.
