Modeling the economic value of Ceribell Rapid Response EEG in the inpatient hospital setting

Abstract

Aims

Potentially life-threatening diagnosis of non-convulsive status epilepticus (NCSE) can only be confirmed with electroencephalography (EEG). When access to EEG is limited, physicians may empirically treat, risking unnecessary sedation and intubation, or not treat, increasing risk of refractory seizures. Either may prolong hospital length of stay (LOS). The current study aimed to examine the effect of a new EEG system (Ceribell Rapid Response EEG, Rapid-EEG) on hospital costs by enabling easy access to EEG and expedited seizure diagnosis and treatment.

Materials and methods

We built a two-armed decision-analytic cost–benefit model comparing Rapid-EEG with clinical suspicion alone for NCSE. Diagnostic parameters were informed by a multicenter clinical trial (DECIDE, NCT03534258), while LOS and cost parameters were from public US inpatient data, published literature, and Center for Medicare and Medicaid Services fee schedules. We calculated reference case estimates from mean values, while uncertainty was assessed using 95% prediction intervals (PI) generated by probabilistic sensitivity analysis (PSA) and ANCOVA sum of squares. All costs were indexed to 2019 US$.

Results

Each use case of Rapid-EEG saved $3,971 to $17,290 as it led to reduction in the hospital LOS by 1.2 days (6.1 vs. 7.4 days) and ICU LOS by 0.4 days (1.5 vs. 1.9 days). Using PSA, Rapid-EEG saving was $5,633 per use case (95% PI: $($4,649 to $6,617), as it led to diminished hospital LOS by 1.1 days (95% PI: 0.9–1.4 days) and reduced ICU LOS by 0.5 days (95% PI: 0.4–0.6 days). Cost-savings were demonstrated in 75% of replications. Sixty-four percent of variance in total costs was attributable to LOS for persons incorrectly diagnosed with seizures.

Limitations

Results were obtained from the analysis of existing data and not a prospective outcome trial.

Conclusions

Rapid-EEG alters the treatment course for patients with suspected seizures and will result in cost savings per patient.

Keywords:

• Electroencephalography
• non-convulsive status epilepticus
• cost–benefit analysis
• decision tree model
• medical device
• neurology
• neuroscience
• seizure
• status epilepticus

Transparency

Declaration of funding

Funding was provided by Ceribell Inc.

Declaration of financial/other relationships

JP is inventor of Rapid EEG and founder of Ceribell Inc., a startup company based in Silicon Valley, CA that is commercializing the Rapid Response EEG system for clinical use. JPN and KG serve as scientific advisors to Ceribell and both have received consulting fees from Ceribell. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. JME peer reviewers on this manuscript have received an honorarium from JME for their review work, but have no other relevant financial relationships to disclose.

Author contributions

JPN and JP designed the study. JPN performed statistical analysis and interpretation, and drafted the initial manuscript. All authors critically revised the manuscript and approved the final version. JPN takes full responsibility for the integrity of the data presented.

Acknowledgements

Ceribell Inc. provided data from the DECIDE trial to inform statistical model parameters.

Previous presentation

Results from this study were presented at the 2020 American Clinical Neurophysiology Society (ACNS) Annual Meeting (Feb 5–9, New Orleans, LA).