Data on health-related costs after aneurysmal subarachnoid hemorrhage (aSAH) are limited. The aim was to evaluate outcome, return to work and costs after aSAH with focus on differences between high- and low-grade aSAH (defined as World Federation of Neurological Surgeons [WFNS] grades 4–5 and WFNS 1–3, respectively).
A cross-sectional study was performed, including all consecutive survivors of aSAH over a 4-year period. A telephone interview was conducted to assess the Glasgow Outcome Scale Extended and employment status before and after aSAH. Direct costs were calculated by multiplying the length of hospitalization by the average daily costs. Indirect costs were calculated for productivity losses until retirement age according to the human capital approach.
Follow-up was performed 2.7 years after aSAH (range 1.3–4.6). Favorable outcome was achieved in 114 of 150 patients (76%) and work recovery in 61 of 98 patients (62%) employed prior to aSAH. High-grade compared to low-grade aSAH resulted less frequently in favorable outcome (52% vs. 85%; p < 0.001) and work recovery (39% vs. 69%; p = 0.013). The total costs were € 344.277 (95% CI 268.383–420.171) per patient, mainly accounted to indirect costs (84%). The total costs increased with increasing degree of disability and were greater for high-grade compared to low-grade aSAH (€ 422.496 vs. € 329.193; p = 0.039). The effective costs per patient with favorable outcome were 2.1-fold greater for high-grade compared to low-grade aSAH (€ 308.625 vs. € 134.700).
Favorable outcome can be achieved in a considerable proportion of high-grade aSAH patients, but costs are greater compared to low-grade aSAH. Further cost-effectiveness studies in the current era of aSAH management are needed.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Diringer MN, Bleck TP, Claude Hemphill J, et al. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference. Neurocrit Care. 2011;15:211–40.
Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43:1711–37.
Schwartz C, Pfefferkorn T, Ebrahimi C, et al. Long-term neurological outcome and quality of life after World Federation of Neurosurgical Societies Grades IV and V Aneurysmal Subarachnoid Hemorrhage in an Interdisciplinary Treatment Concept. Neurosurgery. 2017;80:967–74.
Taylor CJ, Robertson F, Brealey D, et al. Outcome in poor grade subarachnoid hemorrhage patients treated with acute endovascular coiling of aneurysms and aggressive intensive care. Neurocrit Care. 2011;14:341–7.
Ridwan S, Urbach H, Greschus S, von Hagen J, Esche J, Bostrom A. Health care costs of spontaneous aneurysmal subarachnoid hemorrhage for rehabilitation, home care, and in-hospital treatment for the first year. World Neurosurg. 2017;97:495–500.
Rivero-Arias O, Wolstenholme J, Gray A, et al. The costs and prognostic characteristics of ischaemic neurological deficit due to subarachnoid haemorrhage in the United Kingdom. Evidence from the MRC International Subarachnoid Aneurysm Trial. J Neurol. 2009;256:364–73.
Rivero-Arias O, Gray A, Wolstenholme J. Burden of disease and costs of aneurysmal subarachnoid haemorrhage (aSAH) in the United Kingdom. Cost Eff Resour Alloc. 2010;8:6.
Dodel R, Winter Y, Ringel F, et al. Cost of illness in subarachnoid hemorrhage: a German longitudinal study. Stroke. 2010;41:2918–23.
Keller E, Krayenbuhl N, Bjeljac M, Yonekawa Y. Cerebral vasospasm: results of a structured multimodal treatment. Acta Neurochir Suppl. 2005;94:65–73.
Seule MA, Muroi C, Mink S, Yonekawa Y, Keller E. Therapeutic hypothermia in patients with aneurysmal subarachnoid hemorrhage, refractory intracranial hypertension, or cerebral vasospasm. Neurosurgery. 2009;64:86–92 (discussion 3).
Wilson JT, Pettigrew LE, Teasdale GM. Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use. J Neurotrauma. 1998;15:573–85.
Wermer MJ, Kool H, Albrecht KW, Rinkel GJ. Aneurysm Screening after Treatment for Ruptured Aneurysms Study Group. Subarachnoid hemorrhage treated with clipping: long-term effects on employment, relationships, personality, and mood. Neurosurgery. 2007;60:91–7 (discussion 7–8).
Raj R, Bendel S, Reinikainen M, et al. Costs, outcome and cost-effectiveness of neurocritical care: a multi-center observational study. Crit Care. 2018;22:225.
Wostrack M, Sandow N, Vajkoczy P, et al. Subarachnoid haemorrhage WFNS grade V: is maximal treatment worthwhile? Acta Neurochir (Wien). 2013;155:579–86.
Wilson DA, Nakaji P, Albuquerque FC, McDougall CG, Zabramski JM, Spetzler RF. Time course of recovery following poor-grade SAH: the incidence of delayed improvement and implications for SAH outcome study design. J Neurosurg. 2013;119:606–12.
Wallmark S, Ronne-Engstrom E, Lundstrom E. Predicting return to work after subarachnoid hemorrhage using the Montreal Cognitive Assessment (MoCA). Acta Neurochir (Wien). 2016;158:233–9.
Sonesson B, Kronvall E, Saveland H, Brandt L, Nilsson OG. Long-term reintegration and quality of life in patients with subarachnoid hemorrhage and a good neurological outcome: findings after more than 20 years. J Neurosurg. 2018;128:785–92.
Passier PE, Visser-Meily JM, Rinkel GJ, Lindeman E, Post MW. Life satisfaction and return to work after aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 2011;20:324–9.
Roos YB, Dijkgraaf MG, Albrecht KW, et al. Direct costs of modern treatment of aneurysmal subarachnoid hemorrhage in the first year after diagnosis. Stroke. 2002;33:1595–9.
Wilby MJ, Sharp M, Whitfield PC, Hutchinson PJ, Menon DK, Kirkpatrick PJ. Cost-effective outcome for treating poor-grade subarachnoid hemorrhage. Stroke. 2003;34:2508–11.
Lerch C, Yonekawa Y, Muroi C, Bjeljac M, Keller E. Specialized neurocritical care, severity grade, and outcome of patients with aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2006;5:85–92.
Conflict of interest
The authors declare that they have no conflict of interest.
The study protocol was approved by the local ethics committee of the University Zurich, Switzerland (Ref. Nr. EK: KEK-ZH-Nr. 2011-0429).
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Seule, M., Oswald, D., Muroi, C. et al. Outcome, Return to Work and Health-Related Costs After Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care (2020). https://doi.org/10.1007/s12028-019-00905-2
- Subarachnoid hemorrhage
- Employment status