POSA268 Economic and Humanistic Impact of Vasospasm-Related Complications Following Aneurysmal Subarachnoid Hemorrhage; Results of a Systematic Literature Review

Abstract

Cerebral vasospasm (VSP) is the main risk factor of neurological deterioration (i.e., delayed cerebral ischemia [DCI] and cerebral infarction [CI]) after initial aneurysmal subarachnoid hemorrhage (aSAH) and a cause of mortality and morbidity. To identify and present the economic and humanistic burden of VSP-related complications following aSAH. PRISMA guidelines were followed. Systematic searches were conducted in MEDLINE and EMBASE (January 2021) to identify studies published in English presenting economic outcomes and/or humanistic (quality of life [QoL]) for patients with VSP (asymptomatic and symptomatic) following aSAH. Related conferences and additional sources (HTA databases, clinical trial registries) were manually searched. Dual screening, data extraction and qualitative analysis was conducted. Of 3818 studies identified, 40 met inclusion criteria and were selected. Majority of included studies were retrospective analyses or chart reviews based in US single-center hospitals. Economic outcomes were reported in 32 studies (up to 2 years follow up). 10 studies presented humanistic outcomes (up to 12 years follow up). A consistent finding across the studies was the significantly higher economic burden (hospital-care-resource-use [HCRU], hospital costs) for patients with symptomatic VSP vs patients without, after the first aSAH episode and following subsequent re-admissions (p<0.05). Patients with DCI were less likely to retain their independence at 3 months and return to full employment 24 months after aSAH. Symptomatic VSP was also strongly related to depressed mood and poor QoL at 1 year which seems to persist over the long-term (up to 5 years). There was a persistent effect of VSP severity on greater HRCU [5 extra days], requirement for care, institutionalisation, worst QoL at 3 months and hospital costs over time. A substantial direct and indirect economic burden is linked to VSP-related complications. Although limited evidence was identified for humanistic outcomes, these patients tend to suffer from poor QoL with long-lasting burden.