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Healthcare Economics of Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage in the United States

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Abstract

Hydrocephalus is one of the most common sequelae after aneurysmal subarachnoid hemorrhage (aSAH), and it is a large contributor to the condition’s high rates of readmission and mortality. Our objective was to quantify the healthcare resource utilization (HCRU) and health economic burden incurred by the US health system due to post-aSAH hydrocephalus. The Truven Health MarketScan® Research database was used to retrospectively quantify the prevalence and HCRU associated with hydrocephalus in aSAH patients undergoing surgical clipping or endovascular coiling from 2008 to 2015. Multivariable longitudinal analysis was conducted to model the relationship between annual cost and hydrocephalus status. In total, 2374 patients were included; hydrocephalus was diagnosed in 959 (40.4%). Those with hydrocephalus had significantly longer initial lengths of stay (median 19.0 days vs. 12.0 days, p < .001) and higher 30-day readmission rates (20.5% vs. 10.4%, p < .001). With other covariates held fixed, in the first 90 days after aSAH diagnosis, the average cost multiplier relative to annual baseline for hydrocephalus patients was 24.60 (95% CI, 20.13 to 30.06; p < .001) whereas for non-hydrocephalus patients, it was 11.52 (95% CI, 9.89 to 13.41; p < .001). The 5-year cumulative median total cost for the hydrocephalus group was $230,282.38 (IQR, 166,023.65 to 318,962.35) versus $174,897.72 (IQR, 110,474.24 to 271,404.80) for those without hydrocephalus. We characterize one of the largest cohorts of post-aSAH hydrocephalus patients in the USA. Importantly, the substantial health economic impact and long-term morbidity and costs from this condition are quantified and reviewed.

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References

  1. Nieuwkamp DJ, Setz LE, Algra A, Linn FH, de Rooij NK, Rinkel GJ. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol. 2009;8(7):635–42. https://doi.org/10.1016/S1474-4422(09)70126-7.

    Article  PubMed  Google Scholar 

  2. Xie Z, Hu X, Zan X, Lin S, Li H, You C. Predictors of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage? A systematic review and meta-analysis. World Neurosurg. 2017;106:844–60 e6. https://doi.org/10.1016/j.wneu.2017.06.119.

    Article  PubMed  Google Scholar 

  3. Rumalla K, Smith KA, Arnold PM, Mittal MK. Subarachnoid hemorrhage and readmissions: national rates, causes, risk factors, and outcomes in 16,001 hospitalized patients. World Neurosurg. 2018;110:e100–e11. https://doi.org/10.1016/j.wneu.2017.10.089.

    Article  PubMed  Google Scholar 

  4. Alaraj A, Hussein AE, Esfahani DR, Amin-Hanjani S, Aletich VA, Charbel FT. Reducing length of stay in aneurysmal subarachnoid hemorrhage: a three year institutional experience. J Clin Neurosci. 2017;42:66–70. https://doi.org/10.1016/j.jocn.2017.03.049.

    Article  PubMed  Google Scholar 

  5. Jack MM, Peterson JC, McGinnis JP, Alley J, Chamoun RB. Safety, efficacy, and cost-analysis of percutaneous endoscopic gastrostomy and ventriculoperitoneal shunt placement in a simultaneous surgery. World Neurosurg. 2018;115:e233–7. https://doi.org/10.1016/j.wneu.2018.04.024.

    Article  PubMed  Google Scholar 

  6. Lee L, King NK, Kumar D, Ng YP, Rao J, Ng H, et al. Use of programmable versus nonprogrammable shunts in the management of hydrocephalus secondary to aneurysmal subarachnoid hemorrhage: a retrospective study with cost-benefit analysis. J Neurosurg. 2014;121(4):899–903. https://doi.org/10.3171/2014.3.JNS131088.

    Article  PubMed  Google Scholar 

  7. Yamada S, Nakase H, Park YS, Nishimura F, Nakagawa I. Discriminant analysis prediction of the need for ventriculoperitoneal shunt after subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 2012;21(6):493–7. https://doi.org/10.1016/j.jstrokecerebrovasdis.2010.11.010.

    Article  PubMed  Google Scholar 

  8. Kowalski RG, Weintraub AH, Rubin BA, Gerber DJ, Olsen AJ. Impact of timing of ventriculoperitoneal shunt placement on outcome in posttraumatic hydrocephalus. J Neurosurg. 2018;23:1–12. https://doi.org/10.3171/2017.7.JNS17555.

    Article  Google Scholar 

  9. Al-Tamimi YZ, Bhargava D, Feltbower RG, Hall G, Goddard AJ, Quinn AC, et al. Lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage: a prospective, randomized, controlled trial (LUMAS). Stroke. 2012;43(3):677–82. https://doi.org/10.1161/STROKEAHA.111.625731.

    Article  PubMed  Google Scholar 

  10. Blackburn SL, Swisher CB, Grande AW, Rubi A, Verbick LZ, McCabe A, et al. Novel dual lumen catheter and filtration device for removal of subarachnoid hemorrhage: first case report. Oper Neurosurg (Hagerstown). 2018. https://doi.org/10.1093/ons/opy151.

    Article  Google Scholar 

  11. Hansen L. The Truven Health MarketScan databases for life sciences researchers: white paper. IBM Watson Health. 2017. https://truvenhealth.com/Portals/0/Assets/2017-MarketScan-Databases-Life-Sciences-Researchers-WP.pdf. Accessed 25 Feb 2019.

  12. Dorai Z, Hynan LS, Kopitnik TA, Samson D. Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery. 2003;52(4):763–9 discussion 9–71.

    Article  Google Scholar 

  13. Yang TC, Chang CH, Liu YT, Chen YL, Tu PH, Chen HC. Predictors of shunt-dependent chronic hydrocephalus after aneurysmal subarachnoid haemorrhage. Eur Neurol. 2013;69(5):296–303. https://doi.org/10.1159/000346119.

    Article  PubMed  Google Scholar 

  14. O’Kelly CJ, Kulkarni AV, Austin PC, Urbach D, Wallace MC. Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage: incidence, predictors, and revision rates. Clin Article J Neurosurg. 2009;111(5):1029–35. https://doi.org/10.3171/2008.9.JNS08881.

    Article  Google Scholar 

  15. Dasenbrock HH, Angriman F, Smith TR, Gormley WB, Frerichs KU, Aziz-Sultan MA, et al. Readmission after aneurysmal subarachnoid hemorrhage: a nationwide readmission database analysis. Stroke. 2017;48(9):2383–90. https://doi.org/10.1161/STROKEAHA.117.016702.

    Article  PubMed  Google Scholar 

  16. Shigematsu H, Sorimachi T, Osada T, Aoki R, Srivatanakul K, Oda S, et al. Predictors of early vs. late permanent shunt insertion after aneurysmal subarachnoid hemorrhage. Neurol Res. 2016;38(7):600–5. https://doi.org/10.1080/01616412.2016.1199184.

    Article  PubMed  Google Scholar 

  17. Rappleye E. Average cost per inpatient day across 50 states. 2015. https://www.beckershospitalreview.com/finance/average-cost-per-inpatient-day-across-50-states.html. Accessed 12 Aug 2018.

  18. Wilson CD, Safavi-Abbasi S, Sun H, Kalani MY, Zhao YD, Levitt MR, et al. Meta-analysis and systematic review of risk factors for shunt dependency after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2017;126(2):586–95. https://doi.org/10.3171/2015.11.JNS152094.

    Article  PubMed  Google Scholar 

  19. Jabbarli R, Bohrer AM, Pierscianek D, Muller D, Wrede KH, Dammann P, et al. The CHESS score: a simple tool for early prediction of shunt dependency after aneurysmal subarachnoid hemorrhage. Eur J Neurol. 2016;23(5):912–8. https://doi.org/10.1111/ene.12962.

    Article  CAS  PubMed  Google Scholar 

  20. Chou CH, Reed SD, Allsbrook JS, Steele JL, Schulman KA, Alexander MJ. Costs of vasospasm in patients with aneurysmal subarachnoid hemorrhage. Neurosurgery. 2010;67(2):345–51; discussion 51–2. https://doi.org/10.1227/01.NEU.0000371980.08391.71.

    Article  PubMed  Google Scholar 

  21. Hoh BL, Kleinhenz DT, Chi YY, Mocco J, Barker FG 2nd. Incidence of ventricular shunt placement for hydrocephalus with clipping versus coiling for ruptured and unruptured cerebral aneurysms in the Nationwide Inpatient Sample database: 2002 to 2007. World Neurosurg. 2011;76(6):548–54. https://doi.org/10.1016/j.wneu.2011.05.054.

    Article  PubMed  Google Scholar 

  22. Walcott BP, Iorgulescu JB, Stapleton CJ, Kamel H. Incidence, timing, and predictors of delayed shunting for hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2015;23(1):54–8. https://doi.org/10.1007/s12028-014-0072-y.

    Article  PubMed  Google Scholar 

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Funding

Our research group is supported by the National Institutes of Health (NIH KM1 CA 156687 grant).

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Authors and Affiliations

  1. Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA

    Syed M. Adil, Lefko T. Charalambous, Musa Kiyani, Robert Gramer, Beth A. Parente, Promila Pagadala & Shivanand P. Lad

  2. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA

    Beiyu Liu

  3. Department of Neurology, Duke University Medical Center, Durham, NC, USA

    Christa B. Swisher

  4. Minnetronix, Inc., St. Paul, MN, USA

    Laura Zitella Verbick & Aaron McCabe

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  1. Syed M. Adil
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Correspondence to Shivanand P. Lad.

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Adil, S.M., Liu, B., Charalambous, L.T. et al. Healthcare Economics of Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage in the United States. Transl. Stroke Res. 10, 650–663 (2019). https://doi.org/10.1007/s12975-019-00697-9

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