1204. Role of Post-Subarachnoid Hemorrhage Hydrocephalus in Healthcare Resource Utilization in the United States

Authors: Syed M. Adil; Beiyu Liu, PhD; Lefko Charalambous, BS; Musa Kiyani, BS; Robert Gramer, BS; Christa Swisher, MD; Laura Verbick, PhD; Aaron McCabe, PhD; Beth Parente, PA-C; Promila Pagadala, PhD; Shivanand Lad, MD, PhD (Durham, NC)

Introduction: Hydrocephalus is one of the most common sequelae after aneurysmal subarachnoid hemorrhage (aSAH), and it is a large contributor to the condition’s high rate of readmission and mortality. Our objective was to quantify the additional healthcare resource utilization (HCRU) and financial burden incurred by the US health system due to post-aSAH hydrocephalus. Methods: The Truven Health MarketScan® Research database was used to retrospectively quantify the prevalence and HCRU associated with hydrocephalus in aSAH patients who underwent surgical clipping or endovascular coiling from 2008-2015. A multivariable longitudinal analysis was conducted to model the relationship between annual cost and hydrocephalus status. Results: In total, 2374 patients met inclusion criteria and had sufficient HCRU data; hydrocephalus was diagnosed in 959 people (40.4%). Those with hydrocephalus had significantly longer lengths of stay during the initial aSAH encounter (median 19.0 days vs. 12.0 days, p < 0.0001) and higher 30-day readmission rates (20.5% vs. 10.4%, p < 0.0001). With other covariates held fixed, in the first 90 days after aSAH diagnosis, patients who developed hydrocephalus experienced on average a 24.60 times higher cost relative to their annual baseline (95% CI, 20.13 to 30.06; p < 0.001), whereas those without hydrocephalus experienced an average multiplier of 11.52 above baseline (95% CI, 9.89 to 13.41; p < 0.001). The 5-year cumulative median total cost for the hydrocephalus group was $230,282 (IQR, $166,023.65 to $318,962.35) versus $174,897 (IQR, $110,474.24 to $271,404.80) for those without hydrocephalus. Conclusion: We have presented the first large-scale HCRU analysis regarding the burden of post-aSAH hydrocephalus in the US. With ongoing efforts to better identify patients at risk for hydrocephalus—and thus those who would most benefit from early treatment—these results illustrate the magnitude of the financial and healthcare resource benefits that a successful effort could spur.