title: Cost-benefit analysis of an integrated approach to reduce psychosocial trauma following neurosurgery compared with standard care: two-year prospective comparative study of enhanced specialist liaison nurse service for aneurysmal subarachnoid hemorrhage (ASAH) patients and carers.
abstract: BACKGROUND
  Dysfunctional psychosocial stress often follows standard treatment for aneurysmal subarachnoid hemorrhage (ASAH). An enhanced Specialist Liaison Nurse (SLN) service sought to reduce this stress in a 2-year comparative prospective study, and was designed to determine if such a service would be cost-effective?
  
  
  METHODS
  Clinical data based on consultant notes, included Glasgow Coma Scale (GCS) and high-risk bleed score. Psychosocial outcomes used a standardized patient/carer designed questionnaire to compare outcomes of the SLN cohort (n = 184) with retrospective 18/12 control ASAH cohort (n = 142). Costs-benefits analysis identified savings in reduced need for subsequent medical care, time-off-work, and contributions to the economy.
  
  
  RESULTS
  The cohorts were socio-clinically well matched; 54% aged less than 55 years, 83% were middle-class and 32% had children still in school; 65% of SLN patients had high risk bleeds, and 81% were Grade 1 and 2 on the G.C.S. The SLN patients and carers had statistically significantly reduced psychosocial trauma compared to controls, with early and easy accessibility being the key to success of SLN. Net savings of $280,000 per annum at 2003 prices, from reduced time-off work, re-admissions and saved medical time. Prospectively, more than $3.03 million is added to the national economy by the 80% of employed patients returning to work.
  
  
  CONCLUSIONS
  We conclude that an integrated ASAH treatment yields major psychosocial and economic benefits. Dysfunctional stress after an ASAH is not inevitable in the majority of patients. High-technology neurosurgery is not just a public cost but also improves and saves lives and generates revenue.
authors.affiliation: Institute of Health and Community, Bournemouth University, Bournemouth, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Pritchard
authors.forename: Lesley
authors.initials: L
authors.lastname: Foulkes
authors.forename: Dorothy A
authors.initials: DA
authors.lastname: Lang
authors.forename: Glenn
authors.initials: G
authors.lastname: Neil-Dwyer
mesh_terms: D000328:Adult; D017028:Caregivers / Q000523:psychology; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000451:nursing* / Q000523:psychology*; D009739:Nursing Services / Q000191:economics; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011446:Prospective Studies; D013315:Stress, Psychological / Q000209:etiology / Q000451:nursing* / Q000517:prevention & control*; D013345:Subarachnoid Hemorrhage / Q000191:economics / Q000523:psychology / Q000601:surgery*; D013997:Time Factors