Article
Health-economic impact of spontaneous aneurysmal subarachnoid hemorrhage – Analysis of healthcare costs for acute and overall first year in-hospital treatment and consequential expenses for rehabilitation and home care compared to ischemic stroke
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Authors
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Sami Ridwan
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Bonn
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Horst Urbach
- Abteilung für Neuroradiologie, Universitätsklinikum Freiburg
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Susanne Greschus
- Abteilung für Neuroradiologie, Universitätsklinikum Bonn
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Johanna von Hagen, Jonas Esche, Azize Bostroem
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Bonn
| Published: | June 2, 2015 |
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Outline
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Objective: Aneurysmal SAH has a high Case-fatality rate of more than 60%, only 20% of patients show a favourable outcome. Due to early age of onset (median 55 yrs.) and despite the improvements in treatment, the clinical course generates high health-economic expenses. Primary objective was to highlight the health-economic impact of SAH with respect to treatment modality on first year in-hospital care followed by rehabilitation and homecare expenses and compare the results with published data for ischemic stroke.
Method: 101 patients with SAH treated July 2007 through April 2009 were included. Data was collected from the patients' clinical records, prospectively and at 6 and 12 months. Hunt and Hess / WFNS-scale, Fisher grade, Barthel-index, GOS and mRS were used for clinical evaluation. In-hospital expenses were calculated using the German Diagnosis-Related Groups (DRG) as well as Operation and Procedure catalogue (OPS). Rehabilitation costs depended on phase and daily rate and were acquired from rehabilitation units and health insurance companies. Level of care determined the costs for homecare.
Results: 54 % of patients (median age 52 yrs, 70 females) received clipping and 46 % coiling. 22 patients died. Acute in-hospital treatment costs were 18.669 € - 25.072 € compared to 22.701 € - 30.467 € for first-year in-hospital expenses. Clipping was significantly more expensive: p=0.033 for acute and p=0.003 for one year in-hospital expenses, most probably due to longer ICU stay (16d vs. 13d, p=0.045). Notably, the initial clinical presentation was poorer in the clipping group (p=0.039). 70/79 surviving patients received rehabilitation. Clipped patients produced higher rehabilitation costs and longer treatment periods than coiled patients; p=0,001 for expenses (20.290 € vs. 11.771 €) and p= 0,011 for duration (54,4 d vs. 40,5 d). 31,3% of survivals needed homecare of which 52% needed constant care. Overall first year costs were 3.946.662 € (1.696.376 € coiling, 2.250.286 € clipping), i.e. 30.843 € (endovascular group) and 48.919 € (clipping group) per patient compared to formerly published first year treatment expenses of ischemic stroke at 18.517 € per patient.
Conclusions: Despite improvement of treatment over the last years, aneurysmal SAH prevalently affects working individuals with high in-hospital expenses and long-term occupational disability and thus resulting in a relevant economic impact on the health system, exceeding the treatment expenses of ischemic stroke.
