Analysis of Cost and Effectiveness of Treatment in Benign Paroxysmal Positional Vertigo
Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo, characterized by transient, repeated episodes of dizziness triggered by specific head position changes. Despite its high incidence and recurrence rate, there has been limited research focusing on the cost-effectiveness of different treatment strategies for BPPV. This study aimed to analyze the effectiveness and expenditure of various treatment approaches based on the severity of vertigo and patient classification.
The study recruited 137 BPPV patients from the Department of Emergency and General Neurology at the Northern Area of Suzhou Municipal Hospital between January 2016 and May 2017. All participants provided informed consent, and the study was approved by the hospital’s Ethics Committee. The patients underwent a detailed clinical history and general information registration. They were then evaluated using the Dizziness Handicap Inventory (DHI) sub-scale, with a 5-item and 2-item questionnaire, to screen for BPPV. A score greater than 12 on the 5-item questionnaire or greater than 6 on the 2-item questionnaire indicated possible BPPV. The diagnosis was further confirmed using the Dix-Hallpike and Roll-tests to determine the accuracy of BPPV diagnosis and its subtype.
Participants included 45 males and 92 females, aged between 25 and 88 years. Comorbid conditions among the patients included hypertension (44 cases), diabetes (13 cases), hyperlipidemia (26 cases), migraine (5 cases), and cervical spondylosis (57 cases). Based on the severity of vertigo, patients were classified into four groups: Level 0 (no dizziness attack or attacks have stopped), Level I (daily life is not affected during or after vertigo), Level II (forced to stop daily activities during an attack but can recover quickly), Level III (most daily life is affected but remains self-reliant after an attack), Level IV (most daily life is affected and not self-reliant after an attack), and Level V (all daily life is affected, patient is not self-reliant, and requires assistance). The grouping methods are summarized in Table 1.
In the mild group, patients received only drug treatment. One patient experienced a dizziness attack one week after starting medication and was subsequently moved to the moderate group after a positive position-induced test. In the moderate group, four patients experienced recurrent and aggravated symptoms after outpatient treatment and were moved to the severe group, where they received both drug therapy and canalith repositioning procedure (CRP). Inpatient patients were divided into two groups: those receiving both drug and CRP treatment and those receiving only drug therapy, as some patients did not tolerate CRP well.
Outpatient patients were treated with oral betahistine and ginkgo biloba tablets, while inpatient patients received oral betahistine and intravenous vinpocetine, along with other treatments based on comorbid conditions. The Epley or Semont maneuver was used for patients with posterior semicircular BPPV, the BBQ roll or Gufoni maneuver for horizontal semicircular BPPV, and the anti-Epley or Gufoni maneuver for anterior semicircular BPPV.
Therapeutic outcomes were classified into three grades: (1) Cure – complete disappearance of vertigo/dizziness and nystagmus; (2) Efficacy – significant alleviation of vertigo/dizziness and nystagmus; and (3) Ineffective – no improvement or worsening of symptoms. Patients were evaluated at one week and one month after treatment initiation. Outpatient participants were followed up via telephone or clinic visits. The total cost for each group was calculated based on examination fees, drug charges, and repositioning treatment fees.
Statistical analysis was performed using SPSS 17.0. Data were presented as mean ± standard deviation. Analysis of variance (ANOVA) was used for multiple group comparisons, and a t-test was used for between-group comparisons. A Chi-square test was used for categorical data, with a p-value < 0.05 considered statistically significant.
The study found that the majority of participants were female, with no significant differences in gender, semicircular canal involvement, BPPV type, migraine incidence, or diabetes among the four groups. However, there were significant differences in comorbid cervical spondylosis, hyperlipidemia, and hypertension between the mild and severe groups. The mean age of the severe group was significantly higher than that of the mild and moderate groups. There were no significant differences in inpatient or outpatient status among the groups.
In the mild group, three patients were cured after one week, and one patient experienced recurrence, prompting movement to the moderate group. At the one-month follow-up, ten patients were cured, and two experienced recurrence. In the moderate group, 52 patients were cured after one week, with six cases showing no improvement. Four patients were transferred to the inpatient group, and two cases reported symptom alleviation after multiple repositioning sessions. At the one-month follow-up, 52 patients were cured, and two experienced recurrence. In the severe group with CRP, five patients were cured after one week, and 21 were cured after one month, with three cases of recurrence. In the severe group without CRP, two patients were cured after one week, and 42 were cured after one month, with two cases of recurrence. The one-week cure rate in the moderate group was significantly higher than in the mild group, and the one-week cure rate in the severe group with CRP was higher than in the severe group without CRP. There were no significant differences in the one-month cure rate or recurrence rate among the groups.
The cost of diagnosis and treatment varied significantly among the groups. The mild group incurred costs ranging from RMB 87.9 to 350.1 Yuan, with a mean total cost of RMB 192.4 Yuan. The moderate group had a mean total cost of RMB 364.3 Yuan. The severe group with CRP had a mean total cost of RMB 7788.6 Yuan, with an average drug treatment cost of RMB 2339.0 Yuan. The severe group without CRP had a mean total cost of RMB 8315.3 Yuan, with an average drug treatment cost of RMB 2653.2 Yuan. There were no significant differences in costs between the mild and moderate groups or between the severe groups with and without CRP. However, the inpatient group’s costs were significantly higher than the outpatient group’s.
BPPV is a common cause of peripheral vestibular vertigo, and its high incidence and recurrence rate impose a significant burden on healthcare systems and society. The diagnosis of BPPV is typically confirmed through patient history, symptom reports, and positional nystagmus during diagnostic maneuvers. Delayed diagnosis and treatment can increase costs, making it essential to categorize patients accurately and provide individualized treatment.
The study demonstrated that CRP is effective and beneficial for BPPV patients. Treatment based on vertigo classification can reduce healthcare costs and save medical resources. However, the study’s limitations, including the small sample size and short follow-up period, should be addressed in future research.
doi.org/10.1097/CM9.0000000000000063
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