Cost of illness in subarachnoid hemorrhage: a German longitudinal study

Abstract

Background and purpose: Aneurysmal subarachnoid hemorrhage (SAH) is a cerebrovascular disease with a high mortality rate and severe disability. Longitudinal studies investigating health-economic costs in SAH are scare and only one of them analyzed cost-driving factors. The objective was to evaluate first-year costs in German patients with aneurysmal SAH and to identify independent determinants of costs.

Methods: One hundred thirteen incident cases of aneurysmal SAH treated in the Department of Neurosurgery and Neuroradiology at the University of Bonn (catchment area of 500,000 people) between January 2004 and December 2005 were eligible for the study. Cost data were collected using health-economic questionnaires applied at baseline and 6- and 12-month follow-up time. All costs are expressed in (year 2009 values). Clinical assessments were performed using Hunt and Hess scale, Barthel Index, and Rankin Scale. Independent cost-driving factors were determined using multiple regression analysis.

Results: The total first-year costs were 38,300 (95% CI, 34 490 to 43,100) per patient. Direct costs accounted for 58.7% of total costs and were mainly paid by the health insurance (92.0%). Inpatient costs were the main cost component of direct and total costs (42.8% of total costs). The major cost-driving factors of total costs were younger age and worse functional outcome at 12-month follow-up (Barthel Index).

Conclusions: Aneurysmal SAH is a cerebrovascular disease with considerable health-economic burden. Healthcare programs aimed at reducing the burden of SAH on society and individuals should consider cost-driving factors of SAH. Further health-economic studies investigating cost-driving factors of SAH in different countries are needed.