Rising Annual Costs of Dizziness Presentations to U.S. Emergency Departments
dc.contributor.author | Saber Tehrani, Ali S. | en_US |
dc.contributor.author | Coughlan, Diarmuid | en_US |
dc.contributor.author | Hsieh, Yu Hsiang | en_US |
dc.contributor.author | Mantokoudis, Georgios | en_US |
dc.contributor.author | Korley, Fredrick K. | en_US |
dc.contributor.author | Kerber, Kevin A. | en_US |
dc.contributor.author | Frick, Kevin D. | en_US |
dc.contributor.author | Newman‐toker, David E. | en_US |
dc.contributor.author | Schneider, Sandra | en_US |
dc.date.accessioned | 2013-08-02T20:51:40Z | |
dc.date.available | 2014-09-02T14:12:53Z | en_US |
dc.date.issued | 2013-07 | en_US |
dc.identifier.citation | Saber Tehrani, Ali S.; Coughlan, Diarmuid; Hsieh, Yu Hsiang; Mantokoudis, Georgios; Korley, Fredrick K.; Kerber, Kevin A.; Frick, Kevin D.; Newman‐toker, David E. ; Schneider, Sandra (2013). "Rising Annual Costs of Dizziness Presentations to U.S. Emergency Departments." Academic Emergency Medicine (7): 689-696. <http://hdl.handle.net/2027.42/99059> | en_US |
dc.identifier.issn | 1069-6563 | en_US |
dc.identifier.issn | 1553-2712 | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/99059 | |
dc.description.abstract | Objectives Dizziness and vertigo account for roughly 4% of chief symptoms in the emergency department ( ED ). Little is known about the aggregate costs of ED evaluations for these patients. The authors sought to estimate the annual national costs associated with ED visits for dizziness. Methods This cost study of adult U.S. ED visits presenting with dizziness or vertigo combined public‐use ED visit data (1995 to 2009) from the National Hospital Ambulatory Medical Care Survey ( NHAMCS ) and cost data (2003 to 2008) from the Medical Expenditure Panel Survey ( MEPS ). We calculated total visits, test utilization, and ED diagnoses from NHAMCS . Diagnosis groups were defined using the Healthcare Cost and Utilization Project's Clinical Classifications Software ( HCUP ‐ CCS ). Total visits and the proportion undergoing neuroimaging for future years were extrapolated using an autoregressive forecasting model. The average ED visit cost‐per‐diagnosis‐group from MEPS were calculated, adjusting to 2011 dollars using the Hospital Personal Health Care Expenditures price index. An overall weighted mean across the diagnostic groups was used to estimate total national costs. Year 2011 data are reported in 2011 dollars. Results The estimated number of 2011 US ED visits for dizziness or vertigo was 3.9 million (95% confidence interval [ CI ] = 3.6 to 4.2 million). The proportion undergoing diagnostic imaging by computed tomography ( CT ), magnetic resonance imaging ( MRI ), or both in 2011 was estimated to be 39.9% (39.4% CT , 2.3% MRI ). The mean per‐ ED ‐dizziness‐visit cost was $1,004 in 2011 dollars. The total extrapolated 2011 national costs were $3.9 billion. HCUP ‐ CCS key diagnostic groups for those presenting with dizziness and vertigo included the following (fraction of dizziness visits, cost‐per‐ ED ‐visit, attributable annual national costs): otologic/vestibular (25.7%; $768; $757 million), cardiovascular (16.5%, $1,489; $941 million), and cerebrovascular (3.1%; $1059; $127 million). Neuroimaging was estimated to account for about 12% of the total costs for dizziness visits in 2011 ( CT scans $360 million, MRI scans $110 million). Conclusions Total U.S. national costs for patients presenting with dizziness to the ED are substantial and are estimated to now exceed $4 billion per year (about 4% of total ED costs). Rising costs over time appear to reflect the rising prevalence of ED visits for dizziness and increased rates of imaging use. Future economic studies should focus on the specific breakdown of total costs, emphasizing areas of high cost and use that might be safely reduced. Resumen Incremento Anual de los Costes de las Atenciones por Mareo en los Servicios de Urgencias de Estados Unidos Objectivos El mareo y el vértigo suman aproximadamente el 4% de los motivos de consulta en el servicio de urgencias ( SU ). Se conoce poco sobre los costes globales de las evaluaciones del SU en estos pacientes. Se buscó estimar los costes anuales nacionales asociados con las visitas al SU por mareo. Metodología Este estudio de costes de visitas al SU de adultos norteamericanos que acudieron con mareo o vértigo combinó los datos públicos de las visitas a los SU (1995 a 2009) recogidos por el National Hospital Ambulatory Medical Care Survey ( NHAMCS ) y los costes (2003 a 2008) recogidos por el Medical Expenditure Panel Survey ( MEPS ). Se calcularon el total de visitas, el uso de pruebas diagnósticas y los diagnósticos del SU del NHAMCS . Los grupos diagnósticos se definieron según el Healthcare Cost and Utilization Project's Clinical Classifications Software ( HCUP ‐ CCS ). Los datos del año 2011 se documentaron en dólares de 2011. El total de visitas y la proporción de neuroimagen llevada a cabo en los futuros años se extrapoló usando un modelo predictivo autorregresivo. La media del coste por visita al SU por grupo diagnóstico del MEPS se calculó, ajustándose a dólares de 2011, mediante el índice de precios de los Hospital Personal Health Care Expenditures. Se utilizó una media ponderada global entre los grupos diagnósticos para estimar los costes totales nacionales. Resultados El número de visitas al SU en Estados Unidos en 2011 por mareo o vértigo fue de 3,9 millones ( IC 95% = 3,6 a 4,2 millones). El porcentaje de pruebas diagnósticas de imagen llevadas a cabo por tomografía computarizada ( TC ), resonancia magnética ( RM ) o ambas en 2011 se estimó en un 39,9% (39,4% TC , 2,3% RM ). La media de coste por visita al SU por mareo fue de 1.004 dólares de 2011. Los costes totales, extrapolados para todo el país, fueron de 3.900 millones de dólares. Los grupos diagnósticos HCUP ‐ CCS para aquéllos que presentaron mareo o vértigo incluyeron los siguientes (proporción de visitas por mareo; coste por visita al SU ; costes anuales nacionales atribuibles): otológico/vestibular (25,7%; 768 dólares; 757 millones de dólares), cardiovascular (16,5%, 1.489 dólares; 941 millones de dólares) y cerebrovascular (3,1%; 1.059 dólares; 127 millones de dólares). Se estimó una suma en la neuroimagen del 12% del total de costes para las visitas por mareo en 2011 (360 millones de dólares para la TC y 110 millones de dólares para la RM ). Conclusiones Los costes totales en Estados Unidos para los pacientes que acuden por mareo al SU son sustanciales, y se estima que sobrepasan en estos momentos los 4.000 millones de dólares por año (aproximadamente un 4% de los costes totales del SU ). El incremento de los costes con el paso del tiempo parece reflejar el crecimiento de la prevalencia de las visitas al SU por mareo y el aumento de porcentajes de utilización de la neuroimagen. Futuros estudios económicos deberían centrarse en el desglose de los costes totales, y hacer énfasis en las áreas de alto uso y coste que pueden ser reducidas sin riesgo. | en_US |
dc.publisher | Agency for Healthcare Research and Quality. U.S. Department of Health & Human Services | en_US |
dc.publisher | Wiley Periodicals, Inc. | en_US |
dc.title | Rising Annual Costs of Dizziness Presentations to U.S. Emergency Departments | en_US |
dc.type | Article | en_US |
dc.rights.robots | IndexNoFollow | en_US |
dc.subject.hlbsecondlevel | Medicine (General) | en_US |
dc.subject.hlbtoplevel | Health Sciences | en_US |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.identifier.pmid | 23859582 | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/99059/1/acem12168.pdf | |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/99059/2/acem12168-sup-0001-DataSupplementS1.pdf | |
dc.identifier.doi | 10.1111/acem.12168 | en_US |
dc.identifier.source | Academic Emergency Medicine | en_US |
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dc.owningcollname | Interdisciplinary and Peer-Reviewed |
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