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

Abstract

Introduction Cerebral vasospasm (VSP) is the leading risk factor of neurological deterioration (i.e., delayed cerebral ischemia [DCI] and cerebral infarction) after aneurysmal subarachnoid hemorrhage (aSAH) and a cause of morbidity and mortality. The objective of this systematic literature review is to summarize the economic and humanistic burden of VSP and its related complications after aSAH. Methods A predefined protocol was designed, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Systematic searches were conducted in MEDLINE, Embase, and Cochrane (in January 2021) to identify studies reporting economic and/or humanistic (i.e., health-related quality of life [HRQoL]) outcomes for patients with asymptomatic and symptomatic VSP after aSAH. Related conferences and additional sources were searched manually. Dual screening, data extraction, and qualitative analysis were conducted. Results Of 3818 abstracts identified for review, 43 full-text articles representing 42 single studies met the inclusion criteria and were included. Most studies (33) were observational; nine were randomized clinical trials (RCTs). Economic outcomes were reported in 31 studies, and alongside HRQoL outcomes in 4 studies; 7 studies reported HRQoL outcomes only. Forty studies were conducted in single countries, while only 2 RCTs were conducted in multiple countries. Patients diagnosed with VSP or DCI spent between 2.1 and 7.4 days longer in intensive care and between 4.7 and 17 days longer in hospital (total) compared with patients without VSP or DCI. A significantly higher cost burden of US$33,945 (2021 £26,712) was identified for patients with VSP and £9370 (2021 £13,733) for patients with DCI compared with patients without. Patients with DCI were also disadvantaged by being employed for 62 fewer days (during 24-month follow-up), with an estimated mean cost of £3821 (2021 £5600) for days off work. Poor HRQoL was associated with ≥ 1 days with VSP symptoms (odds ratio [OR]: 2.8, 95% confidence interval [CI]: 1.4–5.3), symptomatic VSP (OR: 1.9, 95% CI: 1.0–3.6), and DCI (OR: 2.3, 95% CI: 1.3–4.2), although this was not consistent across all studies. Symptomatic VSP and DCI were identified as significant risk factors for depressed mood (OR: 2.2, 95% CI: 1.0–4.9) and global cognitive impairment (OR: 2.3) at 12 months, respectively. The severity of VSP was a critical predictor of post-aSAH economic and humanistic burden. Similar trends in economic and humanistic burden were identified in the general aSAH patient population. Study design and patient heterogeneity precluded direct metaanalysis of the results. Conclusion A substantial direct and indirect economic burden is linked to VSP and its related complications after aSAH. Although limited evidence was identified for humanistic burden, these patients seem to suffer from poor HRQoL with long-lasting burden. Overall, there is an urgent...

Clinical Burden of Angiographic Vasospasm and Its Complications After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review

“…The search strategies, study selection, and data extraction used here are similar to those published in our systematic review of the economic and humanistic burden of angiographic VSP and its related complications after aSAH [ 12 ]. A systematic search of MEDLINE, Embase, and the Cochrane Library was conducted on 8 January 2021, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines [ 13 ].…”

“…Additionally, studies that examined only the diagnosis or epidemiology of VSP were excluded. Cross-checking of eligible data from our previous systematic review [ 12 ] was also undertaken.…”

“…This study completes our endeavors to elucidate the burden of angiographic VSP and its related complications after aSAH. Previously [ 12 ], we identified a substantial direct and indirect economic burden and poorer health-related quality of life that was long-lasting in aSAH patients who developed angiographic VSP and its related complications, compared with those who did not. Here we report an up-to-date understanding of the clinical burden of angiographic VSP and its related complications after aSAH based on a systematic review of relevant literature that reported comparative or regression-based analyses of aSAH patients.…”

Magnetic resonance analysis of deep cerebral venous vasospasm after subarachnoid hemorrhage in rabbits

“…Moreover, persistent stenosis is seen to be an inducer of increased intracranial pressure, neurological function defect, delayed cerebral ischemia, and poor clinical outcome ( 4 ). The patient's symptoms, however, worsen after treatment, thus prolonging the length of hospital stay, increasing medical costs, and becoming the leading cause of disability and death ( 5 ).…”

The Supratrochlear Artery Sign—A New Piece in the Puzzle of Cerebral Vasospasm

“…This self-limiting narrowing (vasospasm) of the cerebral vessels has a typical onset of three to five days after hemorrhage, with a maximum occurring usually at five to fourteen days, and gradual resolution over two to four weeks. The pathophysiological mechanism still remains unclear [ 1 ].…”