Higher Health Service Costs Associated With Delayed Diagnosis of Functional Neurological Disorder, 2022, Cuoco et al

Abstract

Objective:
Functional neurological disorder (FND) is frequently encountered in clinical practice but commonly misdiagnosed, which might lead to higher direct costs for the health care system. The investigators analyzed the direct costs associated with the diagnosis of FND compared with costs associated with other neurological conditions and explored possible cost trends related to the clinical and demographic features of FND.


Methods:
Consecutive patients attending a general neurology clinic were recruited and underwent a structured assessment aimed to collect information pertaining to their demographic and clinical characteristics, as well as data regarding their prior diagnostic processes (e.g., the number of consulted specialists, number and type of investigations, emergency department visits, etc.). The costs were hence calculated and compared between the study groups.


Results:
A total of 155 consecutive patients were recruited; of these, 18.6% had FND, 55.84% had one or more other neurological disorder (OND), and 27.10% presented with comorbid FND and OND. The total prediagnostic costs (in euros [€]) were higher in the FND group compared with the OND group (median=€289, interquartile range [IQR] €385 vs. median=€98, IQR €216; Mann–Whitney U=879.5, p=0.04). There was a higher diagnostic delay in the FND group compared with the OND group (median=48 months, IQR 60 months vs. median=12 months, IQR 6 months; Mann–Whitney U=162.00, p<0.01). Diagnostic delay significantly correlated with the total costs in the entire study sample (Spearman’s ρ=0.25, p=0.003) but more strongly in the FND group (Spearman’s ρ=0.81, p<0.001). In the FND group, higher numbers of investigations and costs were associated with the presence of a physiological or psychological trigger and multiple symptoms.


Conclusions:
Delayed diagnosis of FND significantly affects health care system costs, and raising awareness about FND to improve the diagnostic process and outcomes is necessary.

Paywall, https://neuro.psychiatryonline.org/doi/full/10.1176/appi.neuropsych.21110288

 

Can't access full article. From this unfortunate thoughts come to mind as this potentially being like the CFS 'put in the bucket' before investigations into other things, and then the guidelines saying don't investigate anything else.

Given this could lead to missing something should such cost assessments not be required to include the cost of missed diagnoses and misdiagnosis?

Otherwise people could claim it's cheaper to treat all hurt legs as if they aren't broken because it saves money on investigation and treatment for that. And you'd hope even laypersons would spot the outcome would be a lot of people whose broken legs hadn't been addressed properly, and expect that 'cost issue' to be part of any work up.

Are these just costs in a very specific narrowed-down timespan and to certain costcodes/orgs/people rather than including to individual, society, those involved with picking up pieces later etc? And if so is it not time that someone from the legal side of things posts a response in these journals for these things noting what the 'cost' of that should be if things weren't done properly in the initial diagnosis process?

 

This is in the same category as saying you saved thousands by not fixing your leaky roof. It's a partial count with mostly fanciful numbers that leaves out most of what's relevant. It can really be said that the one and only goal in biopsychosocial ideology is how patients impact health care, especially costs, reduces people to numbers and labeled as nothing but pesky complaints. Everything else is irrelevant.

Like you say @bobbler, why not literally not care for anyone, then? Let's dispense with all of this, it's way cheaper, as long as no one actually counts the real total impacts. Let's end healthcare entirely, that will save 100% of healthcare expenses. Clearly it's all that matters in BPS land.

Also there's something remarkable about describing how issues they don't know how to deal with are more expensive to deal with than issues where they do, but unable to actually process this fact since they, somehow, believe they can do what they can't. Amazing.

 

I am sure not treating people is cheap for the NHS, I am not so sure its cheap for society given about 1 in 6 people need drugs and medical care. This is literally just "this patient is too complex don't bother" rationing of care. They have been doing it for a long time already so its not new, they have already withdrawn most medical care for chronically ill people anyway, even for many who could be treated better so its not a shocker its cheaper for the NHS but it costs society and the country more.

 

There is a problem in society where localized accounting can show things are great, while overall things are worse, or things are better in patches and worse in other patches. Its local optimization. That little bit of society is better, pity about the whole. Its theoretically supposed to be a function of governments to address this, but since the problems are separated in jurisdiction even within government lots can fall through the cracks. I wrote a blog on this on Phoenix Rising about psychobabble many years ago, though I used a dog analogy and the counting of bones.

I wrote another blog that briefly commented on issues with not running tests. ME is a real problem here in part because we lack the technology to quickly and cheaply figure out what is going on. That in turn is due to decades of underfunding, a different type of neglect.

When patches of a societal system are isolated or weakened, they are vulnerable to special interests, often economic.

 

How on Earth does that work?

Anyway, if the right test is done first it will be cheaper, simple as that. Many diseases are not very expensive to treat once they are diagnosed especially if they are easily cured and many do not need a lot of medical input.

I am sure that a lot of what is misdiagnosed as FND is like ME in that a proper medical history which looks for the right things would be much cheaper as well as being better for patients.

Even when I was much milder and not so clearly ME I got worse with exercise yet no one ever asked about that. When I was in hospital with ME they dismissed everything I said was a problem and insisted it was something else, often the exact opposite to my experience.

Like so many of us I have worked out my own ways of lessening my symptoms but if doctors just listened they would see that we all describe the same problems.

The BPS methods are increasing costs and the patients are being left without proper help.