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

  • Syed M. Adil
  • Beiyu Liu
  • Lefko T. Charalambous
  • Musa Kiyani
  • Robert Gramer
  • Christa B. Swisher
  • Laura Zitella Verbick
  • Aaron McCabe
  • Beth A. Parente
  • Promila Pagadala
  • Shivanand P. LadEmail author
Original Article


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.


Healthcare economics Hydrocephalus Subarachnoid hemorrhage Ventriculoperitoneal shunt 



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

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

Supplementary material

12975_2019_697_MOESM1_ESM.docx (20 kb)
ESM 1 (DOCX 19 kb)
12975_2019_697_MOESM2_ESM.docx (33 kb)
ESM 2 (DOCX 33 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Syed M. Adil
    • 1
  • Beiyu Liu
    • 2
  • Lefko T. Charalambous
    • 1
  • Musa Kiyani
    • 1
  • Robert Gramer
    • 1
  • Christa B. Swisher
    • 3
  • Laura Zitella Verbick
    • 4
  • Aaron McCabe
    • 4
  • Beth A. Parente
    • 1
  • Promila Pagadala
    • 1
  • Shivanand P. Lad
    • 1
    Email author
  1. 1.Department of NeurosurgeryDuke University Medical CenterDurhamUSA
  2. 2.Department of Biostatistics and BioinformaticsDuke University Medical CenterDurhamUSA
  3. 3.Department of NeurologyDuke University Medical CenterDurhamUSA
  4. 4.Minnetronix, Inc.St. PaulUSA

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