Resource Use and In-Hospital Costs after Aneurysmal Subarachnoid Hemorrhage in The Netherlands

Abstract

Introduction

Aneurysmal Subarachnoid Hemorrhage (aSAH) is a severe condition requiring advanced interventions and intensive in-hospital care. The associated financial burden challenges resource allocation and healthcare sustainability.

Research Question

This study aimed to evaluate the in-hospital healthcare consumption and costs for patients hospitalised with aSAH.

Material and Methods

A bottom-up approach was used to assess in-hospital healthcare consumption and costs for aSAH patients at a Dutch referral centre (November 2021-April 2024). Costs were calculated by multiplying resource consumption, extracted from electronic health records, by national reference prices, reflecting actual hospital costs rather than reimbursements or billing. A generalized linear model was used to identify key cost determinants.

Results

A total of 147 patients were included. Mean age was 61 (±12) and 72.8% was female. Median total costs were €31,666 (IQR: €24,167-€50,367) and length of stay was 15 days (IQR: 12-22). Total costs did not differ significantly between clipping (€28,058 (IQR: €24,167-€49,421) and coiling (€30,209 (IQR: €25,482-€50,678). However, procedure costs differed significantly between clipping (€5135 (IQR: €4886-€6000) and coiling (€7159 (IQR: €5583-€8700). The generalized linear model identified World Federation of Neurosurgical Societies grade, length of stay and delayed cerebral ischemia as key determinants of hospital costs.

Discussion and Conclusion

In-hospital costs for aSAH patients are substantial, with length of stay, disease severity and complications as key cost drivers. Total in-hospital costs were comparable between clipping and coiling, but procedure-specific costs varied significantly. Understanding cost distribution and cost drivers can support more efficient resource allocation and ultimately improve the cost-effectiveness of aSAH care.