Yield and cost-effectiveness of tilt table tests combined with video-EEG.

To study the outcomes of a series of consecutive tilt table tests combined with video-EEG (TTVE) at a single center, and assess their cost-effectiveness compared with other neurophysiological tests. We retrospectively reviewed medical records of patients who underwent TTVE studies between March 1st, 2013 to April 1st, 2018. Detailed clinical history, including patient demographics, reasons for referral, anti-seizure medications, and neurophysiological studies obtained prior to the TTVE studies were extracted from chart reviews. The fee for each neurophysiological test was identified from the Centers for Medicare & Medicaid Services. Fifty-two patients underwent TTVE studies. Thirteen patients (25%) were diagnosed with vasovagal syncope, two (3.8%) were diagnosed with postural orthostatic tachycardia syndrome, and three (5.8%) had psychogenic non-epileptic events during the test. Four out of 12 patients stopped anti-seizure medication(s) after the TTVE. Prior to referral for TTVE, an average of $3,748 per person was spent on neurophysiological tests, which were inconclusive. The average fee for one TTVE test was $535.32, and the fee per test affecting diagnosis or management (defined as the cost divided by the yield of the test) was $1,547. The TTVE test is cost-effective in evaluating refractory episodes of loss of consciousness, atypical of epileptic seizures. In addition to diagnosing syncope, TTVE can be valuable in identifying psychogenic events.