Economic Cost of Functional Neurologic Disorders: A Systematic Review, 2023, O'Mahony, Edwards et al

Introduction

Functional Neurological Disorder (FND) represents genuine involuntary neurological symptoms and signs including seizures, weakness and sensory disturbance which have characteristic clinical features, and represent a problem of voluntary control and perception despite normal basic structure of the nervous system. The historical view of FND as a diagnosis of exclusion can lead to unnecessary healthcare resource utilisation, and high direct and indirect economic costs. A systematic review was performed using PRISMA guidelines in order to assess these economic costs, and to assess for any cost-effective treatments.

Methods

We searched electronic databases (Pubmed, PsycInfo, Medline, EMBASE, and the National Health Service Economic Evaluations Database of the University of York) for original, primary research publications between inception of the databases and 8th April 2022. A hand-search of conference abstracts was also conducted. Key search terms included “functional neurological disorder”, “conversion disorder” and “functional seizures”. Reviews, case reports, case series and qualitative studies were excluded. We performed a descriptive and qualitative thematic analysis of the resulting studies

Results

The search resulted in a total of 3,244 studies. 16 studies were included after screening, and exclusion of duplicates. These included: cost-of-illness (COI) studies which were conducted alongside cohort studies without intervention, and included a comparator group, e.g. another neurological disorder (n=4); COI studies which were conducted alongside cohort studies without intervention, and which did not include a comparator group (n=4); economic Evaluations (EE) of interventions which were either pre-post cohort studies (n=6) or randomized controlled trials (n=2). Of these, five studies assessed active interventions, and three studies assessed costs before and after a definitive diagnosis of FND.

Studies showed an excess annual cost associated with FND (range $4,964 to $86,722 2021 USD), which consisted of both direct, but also large indirect costs. Studies showed promise that interventions, including provision of a definitive diagnosis, could reduce this cost (range 9% to 90.7%). No cost-effective treatments were identified. Study comparison was limited by study design and location heterogeneity

Conclusion

FND is associated with significant use of healthcare resources, resulting in economic costs to both the patient and the tax-payer, as well as intangible losses. Interventions, including accurate diagnosis, appear to offer an avenue towards reducing these costs.

Open access, https://n.neurology.org/content/early/2023/06/20/WNL.0000000000207388

 

"Studies showed an excess annual cost associated with FND (range $4,964 to $86,722 2021 USD)"

Only a small variation then.....

 

This suggests to me that the authors want doctors to have the right not to investigate if the patient walking into the doctor's office is "clearly" [sarcasm] somatising because they are/have [fill in your own blank].

Suggested options for the blank :

Too young
Middle-aged
Getting old
Old
Female
Too thin
Fat
Lazy
Just had a baby
Got young children
Approaching menopause
Going through menopause
Past menopause
Obviously well because doctor has x-ray vision

 

If we had a solution to the problem, we would have a solution to the problem. Genius work, folks. Geniuses who think that diagnosis is an intervention. Good grief this is absurd. They "appear to offer an avenue towards reducing costs" would make the most MBA person ever cringe for being so generically empty of substance.

Milking a ridiculous 19th century ideology on the basis of permanently "showing promise". For decades on end, they show the promise that if they worked, they'd work. If only they could get it to work. But they know this is psychological because their treatments can work, as long as the research is heavily biased, or you just skip the research and trust experts at their word. They can't find treatments that work, though. But they have been showing promise for well over a century. Such promise that it makes sense to them to evaluate the cost-effectiveness of hypothetical treatments they haven't found. But they use CBT and the like for reasons.

And when you look at some of the reasons for high costs, it's all their fault:

This is literally all your crap that's responsible for this. *slow clap*

You can't pull a scam like this anywhere else. Eventually someone demands "show me the damn money/thing". No one is asking for it, and so it goes.

Has anyone before ever published a range this ridiculous? For anything? "This thing could be between 1 gram and about the mass of a large mountain". Serious work.

 

Plus nearly all transplant surgeries and aftercare.

There is still no sound medical basis to this version of FND. They might as well be saying that all difficult medical cases, especially where adequate research has not been done, cost people too much and do not make enough money for big medicine to be worth it. This in itself might have a limited justification, based on resource management, but there is a bleed effect into social support. If patients cannot be adequately treated they still need some level of support, including pensions. These attitudes erode that support, and with no hard evidence to back them. Redo the study when there is an objective diagnostic test for this form of FND, such as a blood test! Oh, wait, if you have an objective test you might be close to a biomedical treatment. No, no, no, no, and no is what I imagine them replying to this.

 

One should do a study of misdiagnosis or delayed diagnosis because of this silly idealogy.and the human costs and extra costs of not diagnosing it early.

 

I think this was done decades ago. I wrote a blog on it, I think on Phoenix Rising. I no longer remember the data, but huge numbers were re-diagnosed in time, but only small numbers in a single year. The proponents of this BPS stuff of course dismiss such findings. Of course this was not FND at the time, but I think conversion disorder if I recall correctly.

PS This is without taking into account of the near universal failures in diagnosing things like ME and even fibromyalgia, and currently long covid.

 

Also, this study is almost exclusively about non-epileptic seizures, not about other forms of what they consider FND.

 

Excess cost is a commonly used concept in Health Economics - usually a neutral term meaning "extra cost of doing or not doing A compared to doing or not doing B, without additional health/wellbeing gain" e.g Excess cost of care associated with sepsis in cancer patients: Results from a population-based case-control matched cohort:

"Sepsis imposes substantial economic burden and can result in a doubling of cancer care costs, particularly during the first year of cancer diagnosis. These estimates are helpful in improving our understanding of burden of sepsis along the cancer pathway and to deploy targeted strategies to alleviate this burden."

Given that (irrespective of delivery model) societies are not willing to deploy unlimited resources to healthcare, economics and the terminology of economics are going to be a major part of modern healthcare science and policy. Health advocacy has to be able to work with that.

 

I wonder how much people give up on the medical proffession until something goes horribly wrong.Then go emergemcy or to another who diagnoses correctly. So the rate of rediagnosis is very low or every other shows their biases and wont rediagnose