Resource use and in-hospital costs after aneurysmal subarachnoid hemorrhage in the Netherlands

Abstract

Introduction Aneurysmal Subarachnoid Hemorrhage (aSAH) is a severe condition requiring advanced interventions and intensive in-hospital care. The associated financial burden challenges resource allocation and healthcare sustainability. Research question This study aimed to evaluate the in-hospital healthcare consumption and costs for patients hospitalised with aSAH. Material and methods A bottom-up approach was used to assess in-hospital healthcare consumption and costs for aSAH patients at a Dutch referral centre (November 2021–April 2024). Costs were calculated by multiplying resource consumption, extracted from electronic health records, by national reference prices, reflecting actual hospital costs rather than reimbursements or billing. A generalized linear model was used to identify key cost determinants. Results A total of 147 patients were included. Mean age was 61 (±12) and 72.8 % was female. Median total costs were €31,666 (IQR: €24,167-€50,367) and length of stay was 15 days (IQR: 12–22). Total costs did not differ significantly between clipping (€28,058 (IQR: €24,167-€49,421) and coiling (€30,209 (IQR: €25,482-€50,678). However, procedure costs differed significantly between clipping (€5135 (IQR: €4886-€6000) and coiling (€7159 (IQR: €5583-€8700). The generalized linear model identified World Federation of Neurosurgical Societies grade, length of stay and delayed cerebral ischemia as key determinants of hospital costs. Discussion and conclusion In-hospital costs for aSAH patients are substantial, with length of stay, disease severity and complications as key cost drivers. Total in-hospital costs were comparable between clipping and coiling, but procedure-specific costs varied significantly. Understanding cost distribution and cost drivers can support more efficient resource allocation and ultimately improve the cost-effectiveness of aSAH care.