Outcome, Return to Work and Health-Related Costs After Aneurysmal Subarachnoid Hemorrhage

  • Martin SeuleEmail author
  • Dennis Oswald
  • Carl Muroi
  • Giovanna Brandi
  • Emanuela Keller
Original Work



Data on health-related costs after aneurysmal subarachnoid hemorrhage (aSAH) are limited. The aim was to evaluate outcome, return to work and costs after aSAH with focus on differences between high- and low-grade aSAH (defined as World Federation of Neurological Surgeons [WFNS] grades 4–5 and WFNS 1–3, respectively).


A cross-sectional study was performed, including all consecutive survivors of aSAH over a 4-year period. A telephone interview was conducted to assess the Glasgow Outcome Scale Extended and employment status before and after aSAH. Direct costs were calculated by multiplying the length of hospitalization by the average daily costs. Indirect costs were calculated for productivity losses until retirement age according to the human capital approach.


Follow-up was performed 2.7 years after aSAH (range 1.3–4.6). Favorable outcome was achieved in 114 of 150 patients (76%) and work recovery in 61 of 98 patients (62%) employed prior to aSAH. High-grade compared to low-grade aSAH resulted less frequently in favorable outcome (52% vs. 85%; p < 0.001) and work recovery (39% vs. 69%; p = 0.013). The total costs were € 344.277 (95% CI 268.383–420.171) per patient, mainly accounted to indirect costs (84%). The total costs increased with increasing degree of disability and were greater for high-grade compared to low-grade aSAH (€ 422.496 vs. € 329.193; p = 0.039). The effective costs per patient with favorable outcome were 2.1-fold greater for high-grade compared to low-grade aSAH (€ 308.625 vs. € 134.700).


Favorable outcome can be achieved in a considerable proportion of high-grade aSAH patients, but costs are greater compared to low-grade aSAH. Further cost-effectiveness studies in the current era of aSAH management are needed.


Subarachnoid hemorrhage Outcome Employment status Cost 


Author contributions

MS and EK substantial contributions to to the design of the work. DO contributed to acquisition of data for the work. MS, DO, CM, GB and EK contributed to analysis and interpretation of data as well as revising the work critically with approval of the version to be published and agreement to be accountable for all aspects of the work.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the local ethics committee of the University Zurich, Switzerland (Ref. Nr. EK: KEK-ZH-Nr. 2011-0429).


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2020

Authors and Affiliations

  1. 1.Neurointensive Care UnitUniversity Hospital ZurichZurichSwitzerland
  2. 2.Department of NeurosurgeryKantonsspital St. GallenSt. GallenSwitzerland

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