1432. The Cost of Subarachnoid Hemorrhage: A Review of Articles from The Last Decade

Authors: Natalia Romano Spica; Kurt Yaeger, MD; Dominic Nistal, BA; Alexandra Reynolds, MD; Cappi Lay, MD; Neha Dangayach, MD, MSCR; Chris Kellner, MD (New York, NY)

Introduction: Subarachnoid hemorrhage (SAH) affects 1/10,000 adults globally. SAH is financially straining for the individual patient, for the patient's family, and for the healthcare system. In this literature review, we reviewed studies that have attempted to quantify the cost of SAH over the past decade, including contemporary socioeconomic reporting standards. Methods: Google Scholar and PubMed were queried for articles published from 2008 to 2018 describing the costs of SAH, including direct and indirect costs. Out of the relevant 197 articles, 25 were selected for further review. Exclusion criteria included studies that i) did not include SAH ii) did not include cost. Results: Studies from the last decade represented approximately 2/3 of all results, suggesting a growing interest in this area. Of the included studies, more than half were retrospective reviews based on large national samples; only 10% studies surveyed participants directly. These studies differed in which aspects of a patient’s care were included in the estimates of costs for SAH care, ranging from attempts to quantify a more comprehensive "cost of illness" (3) to variables such as "hospital care" or "medical care" (16), losses in "productivity" (1), "resource utilization" (4). The direct hospital cost of SAH reported in the last decade ranged from $13,760 to $272,989, with indirect costs representing 3% to 71% of total costs. Costs related to inpatient hospital stay were the main drivers of SAH costs in the first year. Conclusion: The variability in reported SAH costs may be due to the variability in methods used to assess such costs. Increased uniformity in reporting standards and which variables are analyzed for SAH cost of illness is needed urgently. Such data could help better inform key stakeholders including patients, families and hospitals and healthcare systems about the true cost of illness for SAH.