PMID- 33486751
OWN - NLM
STAT- MEDLINE
DCOM- 20210713
LR  - 20210713
IS  - 2193-6323 (Electronic)
IS  - 2193-6315 (Linking)
VI  - 82
IP  - 3
DP  - 2021 May
TI  - Health Economic Aspects of Aneurysmal Subarachnoid Hemorrhage: Factors 
      Determining First Year In-Hospital Treatment Expenses.
PG  - 204-210
LID - 10.1055/s-0040-1720982 [doi]
AB  - BACKGROUND:  Spontaneous aneurysmal subarachnoid hemorrhage (SAH) is a common 
      neurosurgical emergency with a high case fatality rate. The clinical course of 
      SAH generates high health economic expenses. Here we highlight possible 
      cost-driving factors for in-hospital care expenses for the first year. 
      Furthermore, results are compared with ischemic stroke treatment. METHODS:  One 
      hundred and one patients with aneurysmal SAH treated in our hospital from 2007 
      through 2009 were included. The Hunt and Hess (HH) scale, World Federation of 
      Neurosurgical Societies (WFNS) scale, Fisher Scale, and further outcome-relevant 
      data were recorded. Expenses were calculated using the German fixed case rate 
      classification system consisting of Diagnosis-Related Groups (DRG) and the 
      Operation and Procedure catalogue (OPS). Overall acute length of stay (LOS) and 
      LOS on the intensive care unit (ICU) were separately evaluated. Expenses were 
      compared with formerly published first-year costs of ischemic stroke. RESULTS: 
       Fifty-four percent of the patients (median age 52 years, 69% females) received 
      coiling and 46% clipping. Acute in-hospital treatment accounted for 82% of total 
      in-hospital expenses, while consequential in-hospital treatment accounted only 
      for 18%. Altogether, the total first-year in-hospital expenses for all patients 
      were as high as euro2,650,002, resulting in average SAH in-hospital treatment 
      expenses of euro26,238 per patient for the first year. Poor clinical condition on 
      admission and longer stay in ICU are the main cost-driving factors. The impact of 
      the aneurysm treatment method is debatable. Only a poor HH grade and longer ICU 
      stay are independent cost-driving factors. SAH treatment expenses are far higher 
      than treatment costs for ischemic stroke in the literature (euro6,731 for first-year 
      inpatient and euro3,287 for outpatient treatment). CONCLUSIONS:  Clinical condition 
      and LOS determine in-hospital expenses after SAH. Aneurysmal SAH prevalently 
      results in a relevant economic impact on the health system exceeding formerly 
      published treatment expenses for ischemic stroke.
CI  - Thieme. All rights reserved.
FAU - Ridwan, Sami
AU  - Ridwan S
AD  - Department of Neurosurgery, University Hospital Bonn, Bonn, Germany.
AD  - Department of Neurosurgery, Paracelsus Hospital Osnabruck, Osnabruck, Germany.
FAU - Urbach, Horst
AU  - Urbach H
AD  - Department of Radiology, University Hospital Bonn, Bonn, Germany.
AD  - Department of Neuroradiology, University Medical Center Freiburg, Freiburg, 
      Germany.
FAU - Greschus, Susanne
AU  - Greschus S
AD  - Department of Radiology, University Hospital Bonn, Bonn, Germany.
AD  - Department of Radiology, Evangelische Kliniken Johanniter- und Waldkrankenhaus 
      Bonn gGmbH, Bonn, Germany.
FAU - Hagen, Johanna Von
AU  - Hagen JV
AD  - Department of Neurosurgery, University Hospital Bonn, Bonn, Germany.
FAU - Esche, Jonas
AU  - Esche J
AD  - Department of Nutrition and Food Science, Universitat Bonn, Bonn, Germany.
FAU - Bostrom, Azize
AU  - Bostrom A
AD  - Department of Neurosurgery, University Hospital Bonn, Bonn, Germany.
AD  - Department of Neurosurgery, MediClin Robert Janker Hospital, Bonn, Germany.
LA  - eng
PT  - Journal Article
DEP - 20210124
PL  - Germany
TA  - J Neurol Surg A Cent Eur Neurosurg
JT  - Journal of neurological surgery. Part A, Central European neurosurgery
JID - 101580767
SB  - IM
MH  - Adult
MH  - Aged
MH  - Female
MH  - *Health Expenditures
MH  - Humans
MH  - Inpatients
MH  - Intensive Care Units/*economics
MH  - Male
MH  - Middle Aged
MH  - Subarachnoid Hemorrhage/*economics/surgery
MH  - Treatment Outcome
COIS- None declared.
EDAT- 2021/01/25 06:00
MHDA- 2021/07/14 06:00
CRDT- 2021/01/24 20:53
PHST- 2021/01/25 06:00 [pubmed]
PHST- 2021/07/14 06:00 [medline]
PHST- 2021/01/24 20:53 [entrez]
AID - 10.1055/s-0040-1720982 [doi]
PST - ppublish
SO  - J Neurol Surg A Cent Eur Neurosurg. 2021 May;82(3):204-210. doi: 
      10.1055/s-0040-1720982. Epub 2021 Jan 24.