1035. Burden of Illness of Aneurysmal Subarachnoid Hemorrhage across Multiple Healthcare Utilization Settings in the United States

Authors: Georgios Maragkos; Loch Macdonald, MD, PhD; Justin Zamirowski; Justin Moore, MD, PhD; Christopher Ogilvy, MD; Ajith Thomas, MD (Brookline, MA)

Introduction: This study aims to evaluate the current economic burden for aSAH patients across all settings of care, including emergency treatment, hospitalization, post-acute care, rehabilitation and other outpatient services. Methods: The Inovalon MORE 2 registry was utilized to conduct a retrospective cohort analysis on patients presenting with aSAH. This registry contains patient-level healthcare data from commercial, Medicare Advantage, and managed Medicaid plan members, who are followed longitudinally across different settings of care (inpatient, outpatient, post-acute care, and home health) post-discharge. Healthcare resource utilization and direct healthcare expenditures were measured among the identified cohort. Subgroup analyses were performed between various treatment pathways to identify their effects on resource utilization and cost. Results: A total of 11,303 registry patients met inclusion criteria and were analyzed. Overall, the unadjusted mean total cost over a variable follow-up period was $78,297. There were significant differences in cost among patient age groups, with the highest costs incurred in the 60-69-year subgroup ($81,376, P<0.001). Female patients had a 5.78% cost overhead in comparison with male patients (P=0.002). Insurance type was significantly associated with overall costs, with Medicaid ($85,369) and Medicare ($84,480) significantly higher than commercial insurance ($73,269, P<0.001). Patients discharged with disability had higher costs ($102,991, P<0.001), while patients who died before discharge had lower costs ($57,661, P<0.001). Among various treatment pathways, patients receiving open or endovascular procedures with the addition of an extraventricular drain had the highest costs ($114,200), while medically treated patients had the lowest ($52,308, P<0.001). Conclusion: There have historically been limitations in following large numbers of patients across different settings of care to delineate costs. In the present study we attempt to overcome this limitation by utilizing a specialized registry. Healthcare interventions aimed at reducing the overall societal burden of aSAH should consider such factors that drive healthcare utilization costs.