Objective: We sought to assess inpatient and emergency department (ED) healthcare utilization in functional neurological disorders (FND) in adults and children, using large federal databases.

Background: FND represents up to 31% of adult neurology outpatient visits, 20% of movement disorders clinics, and up to 10% of neurology inpatient admissions and are a common cause of ED presentations. Psychogenic non-epileptic seizures (PNES) are frequent referrals to epilepsy centers and Epilepsy Monitoring Unit admissions. Despite this, there is little cost and healthcare utilization data available for FND and no data for the pediatric population.

Method: We utilized three large federal healthcare databases, assessing 1) all-payer inpatient hospitalizations, 2) pediatric hospitalizations, and 3) adult/pediatric ED presentations. We assessed adults age 18+ and pediatric patients age 5-17. We used a necessarily narrow and specific definition of FND, utilizing ICD9 diagnosis codes 300.11 “conversion disorder” or 306.0 “musculoskeletal malfunction arising from mental factors”. Costs and healthcare utilization data for FND were compared to other common neurological disorders.

Results: Adult/pediatric FND inpatient admissions were more frequently emergent, had shorter hospital stays but higher rates of common workup (neuroimaging, lumbar puncture and particularly EEG [PNES]) than in other neurological disorders (p<0.0001). In FND patients, there were unexpectedly low inpatient psychiatric consultation rates and were less likely to be seen by physical/occupational/speech therapy. Annual adult inpatient charges (proxy for total costs) for FND in 2014 were estimated at $827,260,087, comparable with refractory epilepsy. Annual pediatric inpatient charges in 2012 were estimated at $70,027,872, comparable with pediatric neuro-inflammatory diseases. Annual adult/pediatric charges for ED visits in 2013 were estimated at $95,237,186.

Conclusion: There were high levels of inpatient and ED healthcare utilization by FND patients, comparable to other investigation-intensive and pharmacologically-demanding neurological disorders. While a likely under-estimate and not including outpatient costs, the total annual charges to the healthcare system were estimated at over $900m annually. These data should inform healthcare policy, given the opportunity to improve care and reduce unnecessary healthcare costs.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/healthcare-utilization-and-emergency-department-inpatient-costs-in-adult-and-pediatric-functional-neurological-disorders/