Comparison of Inpatient and Emergency Department Costs to Research Funding for Functional Neurologic Disorder: An Economic Analysis.

Abstract

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. 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. 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. 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.