Table 2.
Direct costs of vertigo
| Type of health service | Resource use | In % for reported population | Costs [converted to 2016 USDa] |
|---|---|---|---|
| Medical consultations | |||
| Per person | |||
| Primary care provider |
Within 3 months: 1.1 (Czech Republic), 1.8 (Germany), 2.6 (Hungary), 2.4 (Slovenia) (Benecke et al., 2013 [35]) Per year: 5 (Tyrrell et al., 2016 [45]), 6.6 (with comorbid anxiety), 6.4 (without comorbid anxiety) (Wiltink et al., 2009 [46]) |
||
| Specialist |
Within 3 months: 1.8 (Czech Republic), 1.2 (Germany), 1.2 (Hungary), 0.8 (Slovenia) (Benecke et al., 2013 [35]) Per year: 1 (Tyrrell et al., 2016 [45]) |
76 [123] GBP (follow-up visit) (Reddy et al., 2011 [41]) | |
| Emergency department |
Within 3 months: 0.3 (Czech Republic), 0.2 (Germany), 0.4 (Hungary), 0.6 (Slovenia) (Benecke et al., 2013 [35]) Per year 0.3 (0–3) (BVD), 0.1 (0–2.4) (UVD) (Sun et al., 2014 [44]) |
Per year: 274 [289] USD (BVD), 94 [99] USD (UVD) (Sun et al., 2014 [44]), 1004 [1077] USD (any dizziness), 768 [824] USD (otologic / vestibular cause) (Saber Tehrani et al., 2013 [42]) | |
| Hospitalisation |
Within 3 months: 1.7 (days, Czech Republic), 0.4 (days, Germany), 1.0 (days, Hungary), 0.8 (days, Slovenia) (Benecke et al., 2013 [35]) Per year: 2.7 (days, all ED vertigo), 6.7 (days, central neurological vertigo), 2.3 (days, non-central vertigo) (Ammar et al., 2017 [34]) Per year: 1.4 (occasions, BVD), 0.7 (occasions, UVD) (Sun et al., 2014 [44]) |
Per year: 203 [214] USD (BVD), 92 [97] USD (UVD) (Sun et al., 2014 [44]) | |
| Aggregated | |||
| Primary care provider | 14.3% (all outpatient visits) (Lin and Bhattacharyya, 2011 [38]), 1.8% (incident vertigo, general population), 17.1% (lifetime) (Neuhauser et al., 2008 [40]), 61.3% (> 2 visits) (Grill et al., 2014 [37]), 57.1% (with comorbid anxiety), 33.1% (without comorbid anxiety) (Wiltink et al., 2009 [46]) | Per year: 35.54 [51.75] million GBP (Tyrrell et al., 2016 [45] | |
| Specialist |
4.2% (neurology), 1.3% (ENT) (Ammar et al. 2017 [34]), 16.4% (neurology) (McDowell and Moore, 2016 [39]) 30% (neurology, lifetime, vestibular vertigo), 12% (neurology, lifetime, non-vestibular vertigo), 34% (ear-nose-throat, lifetime, vestibular vertigo), 7% (ENT, non-vestibular vertigo) (Neuhauser et al., 2008 [40]) 57.0% (otolaryngology), 21.0% (internal medicine), 2.2% (neurology), 1.2% (cardiovascular) (Lin and Bhattacharyya, 2011 [38]) |
Per year: 10.0 [14.56] million GBP (Tyrrell et al., 2016 [45]) | |
| Emergency department | Per year: 3.9 million (Saber Tehrani et al., 2013 [42]) | 25.7% (all ED visits), trend from 2.7% in 1995 to 3.8% in 2015 (costs, all ED visit) (Saber Tehrani et al., 2013 [42]) | Per year: 3.9 [4.2] billion USD (Saber Tehrani et al., 2013 [42]), 0.68 [0.99] million GBP (Tyrrell et al., 2016 [45]) |
| Hospitalisation | 24.6% (ED vertigo) (Ammar et al., 2017 [34]), 10% (lifetime, vestibular vertigo), 5% (lifetime, non-vestibular vertigo) (Neuhauser et al., 2008 [40]), 8.9% (with comorbid anxiety), 2.8% (without comorbid anxiety) (Wiltink et al., 2009 [46]) | ||
| All visits | Per year: 292,077 (MD), 262,878 (vestibular neuritis), 230,311 (BPPV), 10,143 (vertigo), 1.218 million (all, forecasted by 2020) (Lin and Bhattacharyya, 2011 [38]) | ||
| Diagnostic investigations | |||
| Per person | |||
| CT | 1220 [1265] USD, 164,700 [176,720] USD (positive yield) (Ahsan et al., 2013 [33]), 50,830 [54,540] USD (positive yield) (Ammar et al., 2017 [34]) | ||
| MRI | 2696 [2795] USD, 22,058 [23,668] USD (positive yield) (Ahsan et al., 2013 [33]), 33,575 [36,025] USD (positive yield) (Ammar et al., 2017 [34]), 15,180 [15,737] USD (positive yield) (Gandolfi et al., 2015 [36]) | ||
| All neuroimaging | 39.976 [41,442] USD (positive yield) (Ahsan et al., 2013 [33]) | ||
| Other | 1 (audiology) (Tyrrell et al., 2016 [45]) | ||
| All investigations | 3.2 (instrumental diagnostic procedures) (Grill et al., 2014 [37]) | ||
| Aggregated | |||
| HIT | 5% (McDowell and Moore, 2016 [39]) | ||
| CT | 48% (Ahsan et al., 2013 [33]), 42% (Ammar et al., 2017 [34]), 31% (episodic vertigo), 50.8% (acute constant vertigo), 60.9% (chronic vertigo) (McDowell and Moore, 2016 [39]) |
Per year: 360 [386] million USD (Saber Tehrani et al., 2013 [42]), 406,646 [436,324] USD (Ammar et al., 2017 [34]) Per 3 years: 988,200 [1,060,322] USD (Ahsan et al., 2013 [33]) |
|
| MRI | 9.5%, (Ammar et al., 2017 [34]), 5.3% (Ahsan et al., 2013 [33]), 18.6% (Gandolfi et al., 2015 [36]), 1.2% (episodic vertigo), 9% (acute constant vertigo) (McDowell and Moore, 2016 [39]), 76.2% (Grill et al., 2014 [37]) |
Per year: 201,450 [216,153] USD (ED) (Ammar et al., 2017 [34]), 110 [118] million USD (Saber Tehrani et al., 2013 [42]), 0.38 [0.55] million GBP (MD, incident cases) (Tyrrell et al., 2016 [45]) Per 3 years: 242,640 [260,349] USD (ED) (Ahsan et al., 2013 [33]), 303,600 [333,147] USD (ED) (Gandolfi et al., 2015 [36]) |
|
| All neuroimaging | 12% (total costs, ED visits), trend from 10.0% in 1995 to 47.9% in 2015 (ED vertigo) (Saber Tehrani et al., 2013 [42]), 82% (tertiary vertigo centre patients) (Grill et al., 2014 [37]) | Per 3 years: 1,230,840 [1,275,985] USD (ED), ~ 1,2 [1.24] million USD (potential savings on unremarkable imaging) (Ahsan et al., 2013 [33]) | |
| other | 2.30% (basic vestibular evaluation), 1.96% (caloric test), 1.06% (rotary chair test) (Adams et al., 2017 [32]), 59% (complete neurological examination) (Ammar et al., 2017 [34]), 53.5% (electrocardiography) (Grill et al., 2014 [37]), 31.4% (Dix-Hallpike manoeuvre) (McDowell and Moore, 2016 [39]) | Per year: 0.15 [0.22] million GBP (hearing test, incident cases), 0.61 [0.89] million GBP (audiology) (Tyrrell et al., 2016 [45]) | |
| Therapy | |||
| Per person | |||
| Medication | 1.8 (number of medicines) (Grill et al., 2014 [37]) | ||
| Aggregated | |||
| Medication | 61.0% (all), 25.9% (betahistine), 37.3% (homeopathic) (Grill et al., 2014 [37]), 0.4% - 45% (prevention of attacks) (Tyrrell et al., 2016 [45]), 44.6% (psychiatric, with comorbid anxiety), 12.1% (psychiatric, without comorbid anxiety), 26.8% (dizziness, with comorbid anxiety), 13.5% (dizziness, without comorbid anxiety) (Wiltink et al., 2009 [46]) | Per year: 7.90 [11.72] million GBP (all), 4.19 [6.21] million GBP (betahistine), 1.76 [2.61] million GBP (prochlorperazine), 0.22 [0.33] million GBP (bendrofluazide), 1.63 [2.42] million GBP (cinnarizine), 0.05 [0.07] million GBP (buccastem), (0.06 [0.09] million GBP (cyclizine) (Tyrrell et al., 2016 [45]) | |
| Other | 15.3% (Epley manoeuvre, BPPV) (McDowell and Moore, 2016 [39]), 21.4% (psychotherapy with comorbid anxiety), 5.7% (psychotherapy without comorbid anxiety) (Wiltink et al., 2009 [46]), 41.3% (physical therapy) (Grill et al., 2014 [37]) | Per year: 3.1 [4.6] million GBP (hearing aids) (Tyrrell et al., 2016 [45]) | |
| Total direct cost | |||
| Per person | Per year: 35 [53.79] GBP (routine care) (Yardley et al., 2012 [47]) | ||
| Aggregated | Per year: 61.3 [89.26] million GBP (Tyrrell et al., 2016 [45]) | ||
BVD bilateral vestibular deficiency, BPPV Benign Paroxysmal Positional Vertigo, CT Computed Tomography, ED Emergency department, ENT ear-nose-throat, GBP Great Britain pound, HIT head impulse test, MRI Magnetic Resonance Imaging, MD Meniere’s disease, USD United States dollar; UVD unilateral vestibular deficiency
aCCEMG – EPPI-Centre Cost Converter (Shemilt et al. 2010 [30])