Comparison of Inpatient and Emergency Department Costs to Research Funding for Functional Neurologic Disorder
Christopher D. Stephen, Vicki Fung, David L. Perez, Alberto J. Espay
Abstract
OBJECTIVES: The aim of the study was to assess US inpatient and emergency department (ED) charges for functional neurologic disorder (FND), investigate subtype variations, and compare costs with research funding. METHODS: We used 2009-2019 Healthcare Cost and Utilization Project data to assess adult and pediatric inpatient/ED stays and associated charges in 2019 inflation-adjusted dollars, for ICD-10-defined FND (F.44.4-F44.7) vs neurologic comparators neuroinflammatory/demyelinating diseases, refractory epilepsy, and anterior horn cell diseases. NIH research funding (2017-2023) was assessed using NIH RePORTER. RESULTS: Inpatient charges in 2019 were $1,614.1 million (95% CI $1,492.8-1,735.4 million) for adult FND, a 47% increase since 2017, higher than for comparators, and $105.7 million (95% CI $83.5-127.8 million) for pediatric FND, a 37% increase since 2012, lower than for comparators. ED charges in 2019 were $257.9 million (95% CI $230.1-285.8 million) for adult FND, a 67% increase since 2017, exceeding those of all comparators except refractory epilepsy, and $257.9 million (95% CI $230.1-285.8 million) for pediatric FND, a 108% increase, greater than for comparators. Functional seizures accounted for most FND costs while motor/mixed FND had the highest per-patient costs. Inpatient/ED charges in 2019 for adult/pediatric FND were $2.0 billion, a 49% increase since 2017. The relative proportion of NIH funding to total inpatient/ED charges was lowest for FND vs all neurologic comparators. DISCUSSION: Rising inpatient/ED costs of FND care surpass those of similarly complex neurologic conditions, yet FND receives minimal research funding relative to health care costs.