Evaluation of disease severity and treatment intensity as cost drivers for ruptured intracranial aneurysms

Economic and Humanistic Burden of Cerebral Vasospasm and Its Related Complications after Aneurysmal Subarachnoid Hemorrhage: A Systematic Literature Review

“…Forty studies were conducted in single countries: 20 studies in the USA [ 11 , 26 , 30 , 36 , 39 , 41 – 44 , 46 – 48 , 52 , 56 , 58 – 60 , 63 – 65 ], and the remainder in Australia [ 49 ], Brazil [ 29 ], Canada [ 35 ], China [ 31 ], Estonia [ 24 ], Finland [ 50 ], Germany [ 40 , 53 , 54 ], India [ 28 ], Japan [ 33 ], New Zealand [ 51 ], Poland [ 61 ], Portugal [ 57 ], Turkey [ 37 , 38 ], and the UK [ 32 , 45 , 55 , 62 ]. Two RCTs were conducted in multiple countries: the CONSCIOUS-1 trial [ 27 ] in Austria, Canada, Finland, France, Germany, Israel, Italy, Sweden, Switzerland, the UK, and the USA, and another trial [ 34 ] in Canada, the Netherlands, and the USA.…”

“…The longest study was a retrospective cohort analysis of cost drivers for aneurysms using the US Value Driven Outcomes database, which reported data from a 15.5-year period (July 2001 to January 2017) [ 63 ]. Two RCTs [ 30 , 31 ] and 13 observational studies [ 35 – 38 , 40 – 42 , 45 , 46 , 52 , 56 , 59 , 63 ] collected data after 2010.…”

“…Of the 18 studies that reported baseline Fisher grade, 14 studies [ 28 – 30 , 32 , 33 , 39 , 40 , 43 , 45 , 53 , 59 , 60 , 63 , 65 ] included a patient population with high disease severity, with most patients falling into the Fisher grade 3 category, which has the highest risk for VSP, DCI, and resulting poor outcomes [ 66 ]. Approximately two-thirds or more of patients from 18 studies [ 24 , 26 , 28 – 30 , 34 , 36 , 38 , 40 , 43 , 48 , 50 , 54 , 59 – 61 , 63 , 65 ] had a Hunt–Hess baseline score of ≤ 3 at hospital entry, corresponding to asymptomatic or minimal headache (grade 1), moderate-to-severe headache (grade 2), or drowsiness, confusion, or mild focal deficit (grade 3). Additionally, around half or more of patients from 4 studies [ 11 , 39 , 53 , 55 ] had a Hunt–Hess baseline score of ≥ 3 at hospital entry (grade 4 = stupor, moderate to severe hemiparesis; grade 5 = deep coma).…”

“…Information on aneurysm size was not widely reported among the included studies. Seventeen studies [ 24 , 30 , 32 – 34 , 36 , 38 , 39 , 49 – 51 , 54 , 57 , 59 , 62 , 63 , 65 ] reported information on aneurysm location, with aneurysms more likely (> 50% of patients) to be located anteriorly, although middle, internal, and posterior locations were also described.…”

“…All patients underwent microsurgical clipping in 3 RCTs [ 28 , 29 , 33 ] and 3 observational studies [ 49 , 59 , 61 ]; 1 RCT [ 31 ] and 2 observational studies [ 57 , 62 ] included patients who had only received endovascular coiling. Other reported procedures included endovascular pipeline flow diversion [ 63 ], endovascular drainage [ 36 ], angioplasty [ 47 ], and wrapping [ 53 ].…”