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Watson M, Woodward J, Strom LA. The Financial Burden of Functional Neurological Disorders. Curr Neurol Neurosci Rep 2023; 23:637-643. [PMID: 37695443 DOI: 10.1007/s11910-023-01298-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE OF REVIEW Functional neurological disorder (FND) is a common and severely debilitating condition lacking clinical ownership, existing between neurology and psychiatry. This article reports the findings of recent research investigating the economic costs of FND diagnosis and management. We define what the costs are, why they exist, and suggest actionable steps to reduce them. RECENT FINDINGS The financial burden of FND exists across the globe characterized by high healthcare utilization resulting in exorbitant direct and indirect costs for the patient, healthcare system, and society. Inadequate medical education and stigmatization of the disorder prolong the time to diagnosis, during which cyclical utilization of inpatient and emergency department services drive up costs. Despite being cost-effective, lack of accessible treatment compounds the issue, leaving patients without a reliable exit. Recent findings support an increased awareness and the need for a cultural shift to overcome the financial burden associated with this underserved population.
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Affiliation(s)
- Meagan Watson
- Department of Neurology, University of Colorado, Aurora, CO, USA.
| | - Jared Woodward
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Laura A Strom
- Department of Neurology, University of Colorado, Aurora, CO, USA
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Cuoco S, Scannapieco S, Carotenuto I, Picillo M, Pellecchia MT, Barone P, Erro R. Higher Health Service Costs Associated With Delayed Diagnosis of Functional Neurological Disorder. J Neuropsychiatry Clin Neurosci 2023; 35:86-91. [PMID: 35989570 DOI: 10.1176/appi.neuropsych.21110288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Functional neurological disorder (FND) is frequently encountered in clinical practice but commonly misdiagnosed, which might lead to higher direct costs for the health care system. The investigators analyzed the direct costs associated with the diagnosis of FND compared with costs associated with other neurological conditions and explored possible cost trends related to the clinical and demographic features of FND. METHODS Consecutive patients attending a general neurology clinic were recruited and underwent a structured assessment aimed to collect information pertaining to their demographic and clinical characteristics, as well as data regarding their prior diagnostic processes (e.g., the number of consulted specialists, number and type of investigations, emergency department visits, etc.). The costs were hence calculated and compared between the study groups. RESULTS A total of 155 consecutive patients were recruited; of these, 18.6% had FND, 55.84% had one or more other neurological disorder (OND), and 27.10% presented with comorbid FND and OND. The total prediagnostic costs (in euros [€]) were higher in the FND group compared with the OND group (median=€289, interquartile range [IQR] €385 vs. median=€98, IQR €216; Mann-Whitney U=879.5, p=0.04). There was a higher diagnostic delay in the FND group compared with the OND group (median=48 months, IQR 60 months vs. median=12 months, IQR 6 months; Mann-Whitney U=162.00, p<0.01). Diagnostic delay significantly correlated with the total costs in the entire study sample (Spearman's ρ=0.25, p=0.003) but more strongly in the FND group (Spearman's ρ=0.81, p<0.001). In the FND group, higher numbers of investigations and costs were associated with the presence of a physiological or psychological trigger and multiple symptoms. CONCLUSIONS Delayed diagnosis of FND significantly affects health care system costs, and raising awareness about FND to improve the diagnostic process and outcomes is necessary.
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Affiliation(s)
- Sofia Cuoco
- Department of Medicine, Surgery, and Dentistry "Scuola Medica Salernitana," Neuroscience Section, University of Salerno, Baronissi (SA), Italy (Cuoco, Scannapieco, Carotenuto, Picillo, Erro); Centro Malattie Neurodegenerative, University of Salerno, Baronissi (SA), Italy (Pellecchia, Barone)
| | - Sara Scannapieco
- Department of Medicine, Surgery, and Dentistry "Scuola Medica Salernitana," Neuroscience Section, University of Salerno, Baronissi (SA), Italy (Cuoco, Scannapieco, Carotenuto, Picillo, Erro); Centro Malattie Neurodegenerative, University of Salerno, Baronissi (SA), Italy (Pellecchia, Barone)
| | - Imma Carotenuto
- Department of Medicine, Surgery, and Dentistry "Scuola Medica Salernitana," Neuroscience Section, University of Salerno, Baronissi (SA), Italy (Cuoco, Scannapieco, Carotenuto, Picillo, Erro); Centro Malattie Neurodegenerative, University of Salerno, Baronissi (SA), Italy (Pellecchia, Barone)
| | - Marina Picillo
- Department of Medicine, Surgery, and Dentistry "Scuola Medica Salernitana," Neuroscience Section, University of Salerno, Baronissi (SA), Italy (Cuoco, Scannapieco, Carotenuto, Picillo, Erro); Centro Malattie Neurodegenerative, University of Salerno, Baronissi (SA), Italy (Pellecchia, Barone)
| | - Maria Teresa Pellecchia
- Department of Medicine, Surgery, and Dentistry "Scuola Medica Salernitana," Neuroscience Section, University of Salerno, Baronissi (SA), Italy (Cuoco, Scannapieco, Carotenuto, Picillo, Erro); Centro Malattie Neurodegenerative, University of Salerno, Baronissi (SA), Italy (Pellecchia, Barone)
| | - Paolo Barone
- Department of Medicine, Surgery, and Dentistry "Scuola Medica Salernitana," Neuroscience Section, University of Salerno, Baronissi (SA), Italy (Cuoco, Scannapieco, Carotenuto, Picillo, Erro); Centro Malattie Neurodegenerative, University of Salerno, Baronissi (SA), Italy (Pellecchia, Barone)
| | - Roberto Erro
- Department of Medicine, Surgery, and Dentistry "Scuola Medica Salernitana," Neuroscience Section, University of Salerno, Baronissi (SA), Italy (Cuoco, Scannapieco, Carotenuto, Picillo, Erro); Centro Malattie Neurodegenerative, University of Salerno, Baronissi (SA), Italy (Pellecchia, Barone)
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