J Neurol Surg A Cent Eur Neurosurg 2021; 82(03): 204-210
DOI: 10.1055/s-0040-1720982
Original Article

Health Economic Aspects of Aneurysmal Subarachnoid Hemorrhage: Factors Determining First Year In-Hospital Treatment Expenses

Sami Ridwan
1   Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
2   Department of Neurosurgery, Paracelsus Hospital Osnabruck, Osnabruck, Germany
Horst Urbach
3   Department of Radiology, University Hospital Bonn, Bonn, Germany
4   Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
Susanne Greschus
3   Department of Radiology, University Hospital Bonn, Bonn, Germany
5   Department of Radiology, Evangelische Kliniken Johanniter- und Waldkrankenhaus Bonn gGmbH, Bonn, Germany
Johanna Von Hagen
1   Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
Jonas Esche
6   Department of Nutrition and Food Science, Universität Bonn, Bonn, Germany
Azize Boström
1   Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
7   Department of Neurosurgery, MediClin Robert Janker Hospital, Bonn, Germany
› Author Affiliations


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 €2,650,002, resulting in average SAH in-hospital treatment expenses of €26,238 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 (€6,731 for first-year inpatient and €3,287 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.

Publication History

Received: 20 December 2019

Accepted: 14 April 2020

Article published online:
24 January 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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