Healthcare Economics of Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage in the United States
April 13, 2019 - American Association of Neurological Surgeons, San Diego, CA, Syed M. Adil, Beiyu Liu, et al
Syed M. Adil, BSa; Beiyu Liu, PhDb; Lefko T. Charalambous, BSa; Musa Kiyani, BSa; Robert Gramer, BSa; Christa B. Swisher, MDc; Laura Zitella Verbick, PhDd; Aaron McCabe, PhDd; Beth A. Parente, PA-Ca; Promila Pagadala, PhDa; Shivanand P. Lad MD, PhDa
- Aneurysmal subarachnoid hemorrhage (aSAH) is a common but devastating condition, with fatality rates of 8-61% in the 1-month after diagnosis.1
- Hydrocephalus is one of the most common sequelae after aSAH, with its incidence ranging from 15-58.4% in the acute stage (48-72 hours after SAH) to 4.3-37% in the chronic stage (>14 days after SAH).2
- Management of hydrocephalus involves longer lengths of stay3 and requires placing extraventricular drains, sometimes followed by conversion to ventriculoperitoneal (VP) shunts or endoscopic third ventriculostomy (ETV).
- Though post-aSAH hydrocephalus is recognized as a common and significant concern, there is scarce literature determining its actual monetary or resource cost.
- Quantify the healthcare resource utilization (HCRU) and health economic burden incurred by the US health system due to post-aSAH hydrocephalus.
- Perform a preliminary analysis regarding the effect of timing of permanent CSF diversion procedure (i.e. VP shunt or ETV) on cost.
Methods (Figure 1)
- The Truven MarketScan® Research database was used to retrospectively quantify the prevalence and HCRU associated with hydrocephalus in aSAH patients undergoing surgical clipping or endovascular coiling from 2008-2015.
- Multivariable longitudinal analysis was conducted across 5 years to model the relationship between total annual cost (hospital service cost + medication cost) and hydrocephalus status, controlling for Charlson Comorbidity Index, clipping vs. coiling treatment, sex, and insurance status.
- Performed a non-multivariable analysis across 2 years comparing HCRU for patients undergoing early (≤21 days after admission) vs. late (22-90 days after admission) CSF diversion procedures.
Results (Figures 2-4)
- In total, 2374 patients were included; hydrocephalus was diagnosed in 959 (40.4%).
- In the preliminary HCRU analysis of early vs. late CSF diversion procedures, 306 patients were included.
- Our study characterizes one of the largest cohorts of aSAH patients in the United States.
- The healthcare resource utilization due to post-aSAH hydrocephalus in the United States is substantial, resulting in cost increase of nearly $70,000 in first 90 days and $55,000 at 5 years.
- Future research should further quantify the potential resources that could be saved with early intervention for post-aSAH hydrocephalus.
- Nieuwkamp DJ, Setz LE, Algra A, Linn FH, de Rooij NK, Rinkel GJ. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol.2009;8(7):635-42. doi:10.1016/S1474-4422(09)70126-7.
- Xie Z, Hu X, Zan X, Lin S, Li H, You C. Predictors of Shunt-dependent Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage? A Systematic Review and Meta-Analysis. World Neurosurg. 2017;106:844-60 e6. doi:10.1016/j.wneu.2017.06.119.
- Rumalla K, Smith KA, Arnold PM, Mittal MK. Subarachnoid Hemorrhage and Readmissions: National Rates, Causes, Risk Factors, and Outcomes in 16,001 Hospitalized Patients. World Neurosurg. 2018;110:e100-e11. doi:10.1016/j.wneu.2017.10.089.5
Author Organization Key
- Duke University Medical Center, Department of Neurosurgery
- Duke University Medical Center, Department of Biostatistics and Bioinformatics
- Duke University Medical Center, Department of Neurology
- Minnetronix, Inc, St. Paul, MN, USA