Characterizing the burden of healthcare utilization and expenditure for epilepsy and unclassified seizures in the U.S., 2016-2022.

objectiveSeizures not classified as epileptic or non-epileptic events remain poorly understood in terms of their healthcare impact. This study compares healthcare utilization and costs among U.S. adults with epilepsy and those with unclassified seizures.

methodsThis cross-sectional study used 2016-2022 Medical Expenditure Panel Survey data to analyze adults aged 18 years and older with epilepsy or unclassified seizures, weighted to represent the civilian, non-institutionalized U.S. POPULATION: Individuals with epilepsy were matched to those with unclassified seizures on demographics and socioeconomic characteristics. Healthcare utilization (e.g., office visits, hospitalizations, and prescription fills) was assessed using negative binomial regression, and all-cause expenditures were evaluated with two-part models, adjusting for patient characteristics and the COVID-19 pandemic period. Marginal effects were estimated using recycled predictions.

resultsAn estimated 6.6 million adults had unclassified seizures, with annual healthcare spending totaling $38.9 billion, substantially more than $21.3 billion for 4.5 million adults with epilepsy. Adjusted analyses showed that individuals with unclassified seizures had 38% greater healthcare utilization and $1362 higher average marginal spending per person compared to those with epilepsy. They also had significantly higher rates of hospitalizations and emergency department visits. SIGNIFICANCE: Adults with unclassified seizures and epilepsy represent a high-need population with great healthcare use and costs. These findings highlight the impact of diagnostic uncertainty and care fragmentation, suggesting that improved identification and healthcare coordination could enhance outcomes and reduce inefficiencies. Although based on U.S. data, these insights may be relevant to other healthcare systems facing similar challenges in seizure management. PLAIN LANGUAGE SUMMARY: Some people experience seizures that are not clearly diagnosed as epilepsy or another condition. This study found that U.S. adults with these "unclassified seizures" use more healthcare and experience higher medical costs than those with diagnosed epilepsy. People with unclassified seizures are more likely to visit the emergency department or be hospitalized, while those with epilepsy have higher use and spending on antiseizure medications. Improved follow-up care and clearer diagnostic pathways after emergency visits for unclassified seizures may help reduce healthcare use and costs.