Burden of IIH Rising

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British researchers have documented a sharp uptick in the number of cases of idiopathic intracranial hypertension (IIH) in England—and a con­comitant rise in the costs of treatment.¹

From Jan. 1, 2002, to Dec. 31, 2016, the incidence of IIH rose by 108%, and the number of hospital visits soared by 442%, the researchers found. “The overwhelming increase in patients diagnosed with IIH, and the amount of hospital visits over the study period, was surprising,” said Susan P. Mollan, MBChB, FRCOphth, at University Hospitals Birmingham in the United Kingdom.

What sparked the study? “We had been tasked by the Association of British Neurologists to set up a special interest group that was multiprofessional to write practical guidelines on the man­agement of IIH.² But there was little data showing the demographic shifts and [documenting] how patients were accessing care,” Dr. Mollan said.

PAPILLEDEMA. Severe papilledema secondary to IIH in a young woman. This image was originally published in the ASRS Retina Image Bank. Suber S. Huang, MD, MBA. Papilledema. Retina Image Bank. 2012; Image Number 828. © The American Society of Retina Specialists.

Findings. Dr. Mollan and her col­leagues extracted data on hospital activ­ity in England. After applying exclusion criteria, they confirmed that 23,182 new cases of IIH were diagnosed from 2002-2016, with an incidence of 2.26 per 100,000 in 2002, rising to 4.69 per 100,000 in 2016. The overall incidence was higher in women (7.7 per 100,000) than in men (1.6 per 100,000).

Treatment. Hospital admissions rose from 1,315 per year in 2002 to 7,123 per year in 2016. More than half the study cohort had a single hospital episode and no additional hospital care in the year following diagnosis. However, 37.8% had repeat hospital activity. Most patients (91.6%) were managed medically; 7.6% had a shunt procedure; 0.68% underwent bariatric surgery; and 0.07% underwent optic nerve sheath fenestration.

Costs. The cost of IIH-related hos­pital care climbed from £9.2 million to £49.9 million during the study period—and the researchers estimated that, if this trend continues, the cost will total £462.7 million in 2030.

More surprises. The researchers uncovered two additional surprises: For the first time, IIH in adults was associ­ated with poverty and adverse obstetric outcomes. More than half of cases oc­curred in socioeconomically deprived areas, and pregnant women with IIH were more likely to undergo cesarean sections compared to pregnant women in the general population.

Wake-up call. Overall, the results confirm that the newly developed guidelines² are needed, Dr. Mollan said. “Better strategies for these patients are required when they access emergency care.”

—Jean Shaw

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1 Mollan SP et al. Eye. Published online Oct. 24, 2018.

2 Mollan SP et al. J Neurol Neurosurg Psychiatry. 2018;89(10):1088-1100.

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Relevant financial disclosures—Dr. Mollan: None.

For full disclosures and the disclosure key, see below.

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