Continuous versus routine EEG in critically ill adults: reimbursement analysis of a randomised trial
Valentina Urbano, Jan Nový, Kaspar Schindler, Stephan Rüegg, Vincent Alvarez, Frédéric Zubler, Mauro Oddo, Jong Woo Lee, Andrea O. Rossetti
Abstract
BACKGROUND: Continuous EEG (cEEG) is increasingly used in critically ill patients, but it is more resource-intensive than routine EEG (rEEG). In the US, cEEG generates increased hospitalisation charges. This study analysed hospital-related reimbursement for participants in a Swiss multicentre randomised controlled trial that assessed the relationship of cEEG versus repeated rEEG with outcome. METHODS: We used data of the CERTA study (NCT03129438), including demographics, clinical variables and reimbursement for acute hospitalisations after the Swiss Diagnosis Related Groups billing system. In addition to a comparison between EEG intervention groups, we explored correlations with several clinical variables, using uni- and multivariate analyses. RESULTS: In total, 366 adults were analysed (184 cEEG, 182 rEEG); 123 (33.6%) were women, mean age was 63.8 years (± 15). Median hospitalisation reimbursement was comparable across EEG groups in univariate analysis: cEEG CHF 89,631 (interquartile range [IQR] 45,635–159,994); rEEG CHF 73,017 (IQR 43,031–158,565); p = 0.432. However, multivariate regression disclosed that increasing reimbursement mostly correlated with longer acute hospitalisation (p <0.001), but also with cEEG (p = 0.019) and lack of seizure / status epilepticus detection (a surrogate of survival, p = 0.036). CONCLUSION: In a Swiss Diagnosis Related Groups billing system applied to critically ill adults, reimbursement largely depends on duration of acute hospital stay, whereas cEEG and lack of seizure/ status epilepticus detection also contribute to the bill. This differs from the USA, where charges are directly increased by cEEG.