Abstract
Background
The clinical management of intracranial aneurysms is debated in many countries because of the associated disability risk and costs. Therefore, estimating the costs and explaining their variability will provide important information for decision makers.
Objective
We aimed to evaluate the acute and post-acute health costs of intracranial aneurysm management and to explain the variability in these costs in the Italian National Health System.
Methods
An observational study was conducted on 145 patients who were affected by a (single) ruptured or an unruptured intracranial aneurysm. They were consecutively admitted to 14 Italian hospitals between October 2005 and March 2007. The data collected during the initial hospitalization and three follow-up visits were used to assess the 1-year health costs and the patients’ health status after discharge. Two multivariate regression models were used to explain the variability in the acute and post-acute costs.
Results
The average total cost per patient was €30,813 (evaluation year: 2012). The first model explained the acute costs fairly well and showed that the severity of illness, the admission unit (i.e., intensive care unit vs. another unit of the hospital), and mortality were associated with large, significant (p < 0.05) coefficients. The second model outperformed the first one in explaining the post-acute costs and showed that health status assessed 30 days after discharge was a significant (p < 0.05) predictor of costs.
Conclusion
Policies aimed at containing health costs should focus on interventions that help to reduce disability, which is a key predictor of long-term costs.
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Notes
ICU versus another unit in the hospital.
The mRS is a disease-specific scale that is widely used with stroke patients to define clinically discrete disability categories. This outcome measure does not include the ‘death’ status.
The model explains about 48 % of the variability by including the health status assessed 12 months after discharge, though this time period would make the model’s estimates strictly retrospective.
We refer to discharge records of the Ministry of Health (http://www.salute.gov.it).
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Authors’ contributions
All authors were involved in drafting the manuscript and revising it critically for important intellectual content, and they all gave final approval of the version to be published. Rosanna Tarricone and Aleksandra Torbica contributed equally to the conception and design of the cost analysis. Stefano Calciolari made substantial contributions to the data collection, analysis, and interpretation, and he is the guarantor of the overall content.
Funding: The study was supported by institutional funds from CERGAS Università Bocconi.
Conflicts of interest
The authors have no conflicts of interest that are directly relevant to the content of this paper.
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Calciolari, S., Torbica, A. & Tarricone, R. Explaining the Health Costs Associated with Managing Intracranial Aneurysms in Italy. Appl Health Econ Health Policy 11, 427–435 (2013). https://doi.org/10.1007/s40258-013-0041-1
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DOI: https://doi.org/10.1007/s40258-013-0041-1