title: Health Care Costs of Spontaneous Aneurysmal Subarachnoid Hemorrhage for Rehabilitation, Home Care, and In-Hospital Treatment for the First Year.
abstract: BACKGROUND
  Given the young age of onset and high probability of long-term disability after subarachnoid hemorrhage (SAH), the financial impact is expected to be substantial. Our primary objective was to highlight subsequent treatment costs after the acute in-hospital stay, including rehabilitation and home care, compared with costs for ischemic stroke.
  
  
  METHODS
  The study included 101 patients (median age 52 years, 70 women) with aneurysmal SAH treated from July 2007 to April 2009. In-hospital costs were calculated using German diagnosis related groups. Rehabilitation costs depended on rehabilitation phase/grade and daily rate. Level of severity of care requirements determined the costs for home care.
  
  
  RESULTS
  Of patients, 54% received coiling and 46% received clipping. The clipping group included more poor-grade patients than the coiling group (P = 0.039); 23 patients died. Of 78 surviving patients, 70 received rehabilitation treatment (68 in Germany). Mean rehabilitation costs were €16,030 per patient. Patients in the clipping group generated higher rehabilitation costs and longer treatment periods in rehabilitation facilities (P = 0.001 for costs [€20,290 vs. €11,771] and P = 0.011 for duration (54.4 days vs. 40.5 days). Of surviving patients, 32% needed home care, of whom 52% required constant care. Multivariate regression analysis identified longer intensive care unit stay and poor Hunt and Hess grade as independent predictors of higher costs.
  
  
  CONCLUSIONS
  Aneurysmal SAH prevalently affects working individuals with long-term occupational disability necessitating long-term medical rehabilitation for most patients and subsequent nursing care in one third of survivors. Overall, SAH treatment generates far higher costs than reported for ischemic stroke.
authors.affiliation: Department of Neurosurgery, University Hospital Bonn, Bonn, Germany. Electronic address: sami.ridwan@yahoo.de.
authors.forename: Sami
authors.initials: S
authors.lastname: Ridwan
authors.affiliation: Department of Radiology, University Hospital Bonn, Bonn, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Urbach
authors.affiliation: Department of Radiology, University Hospital Bonn, Bonn, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Greschus
authors.affiliation: Department of Neurosurgery, University Hospital Bonn, Bonn, Germany.
authors.forename: Johanna
authors.initials: J
authors.lastname: von Hagen
authors.affiliation: Department of Nutrition and Food Science, University of Bonn, Bonn, Germany.
authors.forename: Jonas
authors.initials: J
authors.lastname: Esche
authors.affiliation: Department of Neurosurgery, University Hospital Bonn, Bonn, Germany.
authors.forename: Azize
authors.initials: A
authors.lastname: Boström
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000191:economics* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D000066530:Neurological Rehabilitation / Q000191:economics* / Q000706:statistics & numerical data; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D013345:Subarachnoid Hemorrhage / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Costs; Economics; Expenses; Health care; Ischemic stroke; Subarachnoid hemorrhage; Treatment