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Abstract Details

Economic Disparity in Functional Neurological Disorder: Rising Healthcare Costs, Low Research Investment
General Neurology
P8 - Poster Session 8 (8:00 AM-9:00 AM)
11-007
To assess U.S. inpatient and emergency department (ED) charges for functional neurological disorder (FND), investigate subtype variations, and compare costs relative to research funding across major neurological diagnoses.
FND have high costs and healthcare utilization comparable with investigation and pharmacologically-intensive neurological disorders. There is no data regarding variation of costs within FND subtypes, or comparison with federal research funding.

We used 2008-2019 Healthcare Cost and Utilization Project data to assess all-payer adult (≥18 years) and pediatric (5-17 years) inpatient and ED stays, and associated charges in 2019 inflation-adjusted US dollars, for ICD-10-defined FND (F.44.4-F44.7) versus neurological comparators neuro-inflammatory/demyelinating diseases, refractory epilepsy, and anterior horn cell diseases. Extramural NIH research funding from 2017-2023 was assessed using NIHRePORTER.
2019 calendar year charges (95% confidence interval) were assessed. Adult FND inpatient charges were $1,614.1 million ($1,492.8-1,735.4 million), increasing 47% since 2017, higher than neurological comparator groups. Pediatric FND inpatient charges were $105.7 million ($83.5-127.8 million), increasing 37% since 2012, lower than comparator groups. Adult FND ED charges were $257.9 million ($230.1-285.8 million), increasing 67% since 2017, exceeding all comparator groups except refractory epilepsy. Pediatric FND ED charges were $257.9 million ($230.1-285.8 million), increasing 108%, greater than comparator groups. Functional seizures accounted for most FND costs, given greater admission/presentation volume, while motor and mixed FND had the highest per-patient costs. Total 2019 inpatient and ED charges for adult and pediatric FND were $2.0 billion, increasing 49% since 2017. The relative proportion of NIH funding to total inpatient and ED charges was lowest in FND versus all neurological comparators.
There is unabated increase in the prevalence and annual costs of inpatient and ED FND care for adults and children, exceeding $2 billion in 2019. These costs surpass those of similarly complex neurological conditions, yet FND receives limited research funding relative to these healthcare costs.
Authors/Disclosures
Christopher D. Stephen, MB ChB, FRCP, MSc, SM
PRESENTER 		The institution of Dr. Stephen has received research support from Sanofi. Dr. Stephen has received research support from National Institutes of Health.
Vicki Fung An immediate family member of Vicki Fung has received personal compensation for serving as an employee of Vertex Pharmaceuticals. An immediate family member of Vicki Fung has stock in Vertex Pharmaceuticals. The institution of Vicki Fung has received research support from NIH. The institution of Vicki Fung has received research support from AHRQ. The institution of Vicki Fung has received research support from Google LLC.
David L. Perez, MD, FAAN (Massachusetts General Hospital) Dr. Perez has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley: Brain and Behavior. Dr. Perez has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Psychiatric Association Publishing. The institution of Dr. Perez has received research support from NIH. The institution of Dr. Perez has received research support from Sidney R. Baer Jr. Foundation. The institution of Dr. Perez has received research support from Warren Alpert Foundation. Dr. Perez has received publishing royalties from a publication relating to health care. Dr. Perez has received publishing royalties from a publication relating to health care.
Alberto J. Espay, MD, FAAN (University of Cincinnati) Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Tanabe Pharma America (formerly, Neuroderm). Dr. Espay has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Avion. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amneal. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Acadia. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Acorda. Dr. Espay has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kyowa Kirin. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sunovion. Dr. Espay has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Herantis Pharma. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Supernus (formerly USWorldMeds). Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Acadia. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Synaps Dx. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bial. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for NeuroDiagnostics, Inc (SYNAPS Dx). Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Intrance Medical Systems, Inc.. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merz. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Praxis Precision Medicines. Dr. Espay has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Citrus Health. Dr. Espay has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AskBio. The institution of Dr. Espay has received research support from NIH. The institution of Dr. Espay has received research support from Michael J Fox Foundation for Parkinson's Research. Dr. Espay has received intellectual property interests from a discovery or technology relating to health care. Dr. Espay has received publishing royalties from a publication relating to health care. Dr. Espay has received publishing royalties from a publication relating to health care. Dr. Espay has received publishing royalties from a publication relating to health care.