Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA.
Transl Stroke Res. 2019 Dec;10(6):650-663. doi: 10.1007/s12975-019-00697-9. Epub 2019 Mar 13.
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.
脑积水是蛛网膜下腔出血（aSAH）后最常见的后遗症之一，也是导致再入院率和死亡率居高不下的主要原因。我们的目的是量化美国卫生系统因 aSAH 后发生脑积水而导致的医疗资源利用（HCRU）和健康经济负担。本研究使用 Truven Health MarketScan Research 数据库，回顾性地量化了 2008 年至 2015 年期间接受手术夹闭或血管内栓塞治疗的 aSAH 患者中与脑积水相关的患病率和 HCRU。采用多变量纵向分析来建立年度成本与脑积水状态之间的关系。共纳入 2374 例患者；其中 959 例（40.4%）诊断为脑积水。患有脑积水的患者初始住院时间明显更长（中位数 19.0 天 vs. 12.0 天，p<.001），30 天再入院率更高（20.5% vs. 10.4%，p<.001）。在固定其他协变量的情况下，在 aSAH 诊断后的前 90 天，与年度基线相比，脑积水患者的平均成本乘数为 24.60（95%CI，20.13 至 30.06；p<.001），而非脑积水患者的成本乘数为 11.52（95%CI，9.89 至 13.41；p<.001）。脑积水组的 5 年累计中位数总费用为 230282.38 美元（IQR，166023.65 至 318962.35），而非脑积水组为 174897.72 美元（IQR，110474.24 至 271404.80）。本研究对美国最大的 aSAH 后脑积水患者队列之一进行了描述。重要的是，本研究量化并回顾了该疾病带来的巨大健康经济影响以及长期发病率和成本。
