Yield and cost-effectiveness of tilt table tests combined with video-EEG

Document Type

Journal Article

Publication Date

12-1-2019

Journal

Epileptic Disorders

Volume

21

Issue

6

DOI

10.1684/epd.2019.1109

Keywords

cost-effectiveness; psychogenic non-epileptic seizure; seizure; syncope; tilt table video-EEG

Abstract

Aim. To study the outcomes of a series of consecutive tilt table tests combined with video-EEG (TTVE) at a single center, and assess their cost-effectiveness compared with other neurophysiological tests. Methods. We retrospectively reviewed medical records of patients who underwent TTVE studies between March 1 , 2013 to April 1 , 2018. Detailed clinical history, including patient demographics, reasons for referral, anti-seizure medications, and neurophysiological studies obtained prior to the TTVE studies were extracted from chart reviews. The fee for each neurophysiological test was identified from the Centers for Medicare & Medicaid Services. Results. Fifty-two patients underwent TTVE studies. Thirteen patients (25%) were diagnosed with vasovagal syncope, two (3.8%) were diagnosed with postural orthostatic tachycardia syndrome, and three (5.8%) had psychogenic non-epileptic events during the test. Four out of 12 patients stopped anti-seizure medication(s) after the TTVE. Prior to referral for TTVE, an average of $3,748 per person was spent on neurophysiological tests, which were inconclusive. The average fee for one TTVE test was $535.32, and the fee per test affecting diagnosis or management (defined as the cost divided by the yield of the test) was $1,547. Conclusions. The TTVE test is cost-effective in evaluating refractory episodes of loss of consciousness, atypical of epileptic seizures. In addition to diagnosing syncope, TTVE can be valuable in identifying psychogenic events. st st

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