Table 1 Characteristics of selected studies

Adams, M.E., et al., 2017 [32]; USA

retrospective review of Medicare data Health Care Financing Administration Common ProcedureCoding System

different geographic regions of the USA

2000–2010

dizziness, not otherwise specified, vertigo of central origin; MD; BPPV; other peripheral vestibular disease

5798 patients with vestibular testing from 63,578 with vestibular diagnosis; from total 231,984 patients

• inclusion: age ≥ 65

• mean age not reported; 68% female

resource use for diagnostic investigations in rate of population

Ahsan, S.F., et al., 2013 [33]; USA

retrospective chart review

emergency department

January 2008–January 2011

ICD–9 codes 386.11 (BPPV) or 780.4 (Dizziness and giddiness)

1681 patients

• inclusion: ED visit due to vertigo; being assigned to the health system’s health maintenance organization, for clinical and cost data accessibility

• exclusion: history of severe neurologic diseases

• mean age 56.9; 67.2% female

resource use for imaging in rate of population and monetised cost aggregated to a clinic and projected to positive yield

Ammar, H., et al.,2017 [34]; USA

retrospective chart review

emergency department

January 1, 2011 – December 31, 2011

ICD-9 codes 780.4 (Dizziness and giddiness), 781.2 (Abnormality of gait, 386.0 (MD), 386.1 (Other and unspecified peripheral vertigo), 386.2 (Vertigo of central origin)

521 patients

• inclusion: ED visit due to dizziness; age ≥ 18

• exclusion: syncope

• mean age 49.3; 57.8% female

• resource use for specialist visit in rate of population

• resource use for imaging in rate of population and monetised cost aggregated to a clinic and projected to positive yield

• resource use for hospitalisations in number of occasions per patient and in rate of population

Benecke, H., et al., 2013 [35]; Czech Republic, Germany, Hungary, Slovenia

multi-country, observational, data of Registry to Evaluate the Burden of Disease in Vertigo

general practitioners, specialists (ear-nose-throat, neurologist), emergency department

April 20, 2007 - August 15, 2009

MD, BPPV, other vertigo of peripheral vestibular origin, or peripheral vestibular vertigo of unknown origin

4294 patients of incident vertigo included in the registry, of which from

• Czech Republic 559

• Germany 99

• Hungary 1320

• Slovenia 130

• 65.3% female

• resource use for primary care, specialist, and ED visits and hospitalisations in number of occasions per patient

• indirect: work absenteeism in number of occasions per patient; disability in rate of population

Gandolfi, M.M., et al.,2015 [36]; USA

retrospective chart review

academic specialty centre

January 1, 2010 - August 30, 2013

Unilateral Vestibular Weakness

• 1358 included patients from 1996 vertigo patients

• inclusion: visit due to vertigo, unilateral caloric weakness (≥20%), abnormal ocular motor testing, and nystagmus on positional testing

• mean age 62; 69.4% female

resource use for imaging in rate of population and monetised cost aggregated to a clinic and projected to positive yield

Grill, E., et al.,2014 [37]; Germany

retrospective cohort study; patient-reported questionnaire data

all level health services utilization prior to visiting a tertiary care centre

2011 to 2012

BPPV, MD, vestibular paroxysmia, functional vertigo, bilateral vestibulopathy, vestibular migraine

2374 patients of a tertiary vertigo centre as convenience sample

• inclusion: age ≥ 18

• mean age 55.3; 59.8% female

resource use for primary care visits, diagnostic investigations, imaging, medication, and therapeutic measures in rate of population

Lin and Bhattacharyya, 2011 [38]; USA

retrospective chart review on national level from National Ambulatory Medical Care Survey

all outpatient visits, national level

2005 to 2007

ICD–9 codes 386.00, 386.03 (MD), 386.12 (Vestibular neuritis), 386.11 (BPPV), 386.10, 386.19, 386.20, 438.85, 386.10 (other vertigo); [sensorineural hearing Loss]

4.48 million outpatient visits due to an otologic diagnosis; patient number not provided

• age ≥ 65

• mean age 77.4, 63% female

resource use in rate of population for all outpatient and specialist visits, and in number of occasions aggregated to national level

McDowell, T. and F. Moore, 2016 [39]; Canada

retrospective chart review

emergency department

1 January 1, 2011 - December 31, 2011

ICD–9 codes 386.11 (BPPV) or 780.4 (Dizziness and giddiness)

642 included patients from 1196 vertigo patients

• exclusion: non-neurovestibular vertigo

• mean age 63; 60.3% female

resource use for imaging, specialist visit, and diagnostic investigation in rate of population

Neuhauser, H.K., et al.,2008 [40]; Germany

cross-sectional, questionnaire data from the National Health Interview Survey

German representative sample

12 months prior to the interview in 2003

MD, migrainous vertigo, orthostatic dizziness, and BPPV

1003 individuals with dizziness/vertigo from the 4869 participants

• 243 vestibular vertigo

• 742 nonvestibular dizziness

• 18 uncatogorised

• age range 18–79 years

• resource use for primary care and specialist visits, and hospitalisation in rate of population

• indirect: work absenteeism and disability in rate of population

Reddy et al., 2011 [41]; UK

prospective cohort

nurse-led dizziness clinic

July 2007 to May 2009

BPPV

99 consecutive patients

• 25 males, mean age 61 years;

• 74 females, mean age 58.2

monetised cost per patient for specialist visit

Saber Tehrani, A.S., et al., 2013 [42]; USA

time-series cost analysis; prevalence data from the National Hospital Ambulatory Medical Care Survey (1995–2000, 2005–2009); cost data (2003 to 2008) from the Medical Expenditure Panel

emergency department, national level

estimated for 2011

ICD-9 codes 780.4 (Dizziness and giddiness) or 386.x (Vertiginous syndromes and other disorders of vestibular system)

12,202 dizziness visit and 360,424 non- dizziness visits in 15-years

• inclusion: age ≥ 16

• resource use in number of occasions and in rate of visits for ED visit aggregated to national level

• monetised cost per patient and aggregated to national level for ED visit

• resource use in rate of population and in monetised cost aggregated to national level for imaging

Skoien et al., 2008 [43]; Norway

register-based prospective study, National Insurance Services data

national level

1996–2002

H82 (vertiginous syndrome), and N17 (vertigo/dizziness)

694 female and 326 male vertigo patients from 920,139 women and 1,019,216 men

indirect: disability in rate of population

Sun, D.Q., et al., 2014 [44]; USA

cross-sectional; patient-reported Dizziness Handicap Index and Health Utilities Index Mark 3; costs based on Medicare reimbursement figures and US Bureau of Labor Statistics data

academic medical centre

12 months prior to the survey in 2013

Vestibular deficiency including MD, verified by caloric nystagmography

15 patients with bilateral vestibular deficiency (BVD) and 22 patients with unilateral vestibular deficiency (UVD); 23 healthy controls

• BVD: mean age 65, 27% female UVD: mean age 62, 59% female

• resource use in number of occasions and monetised cost per patient for ED visit, and hospitalisation

• Indirect: work absenteeism and consequences in number of occasions per patient

Tyrrell et al., 2016 [45]; UK

retrospective chart review, data from UK Biobank 2007–2012; Hospital Episode Statistics, UK Meniere’s Society.

national estimation

2013–2014

ICD-10 H810 (MD)

1376 patients from 502,682 UK Biobank participants

• 37–73 years

• Extrapolated toyearly incidence: 2719 cases (i.e. 4.3 per 100,000

estimated prevalence: (0.25%; ~ 162,000 patients)

• resource use in number of occasions per patient and monetised costs aggregated to national level for primary care, specialist, and ED visits

• monetised costs aggregated to national level for imaging, diagnostic investigation, medication, therapeutic measures, and total direct cost

• Indirect: work absenteeism, disability, and consequences in monetised costs aggregated to national level

Wiltink, J., et al., 2009 [46]; Germany

cross-sectional interview-based survey

German representative sample

12 months prior to the survey in 2006

patient-reported dizziness in the past 4 weeks

201 dizziness patients from 1269 participants

• all participants: mean age 48.8; 54.6% female

• vertigo patients: mean age 58.8; 59.7% female

• resource use in number of occasions per patient and in rate of population for primary care visits

• resource use in rate of population for hospitalisation, medication, and therapeutic measures

• Indirect: consequences in rate of population

Yardley et al., 2012 [47]; UK

three arm, pragmatic, randomised controlled trial

primary care

October 2008 to January 2011

Vestibular vertigo, assessed by the primary health care provider

337 patients participating in any of the survey waves; 263 in all

• inclusion: vertigo-related diagnostic and medication terms in practice records

• exclusion: non-labyrinthine cause of dizziness, serious comorbidity, language barriers

• mean age 59.4; 71% female

monetised total direct cost per patient