Health-related quality of life and cost-effectiveness of treatment in subarachnoid haemorrhage.

Background: Treatment of aneurysmal subarachnoid haemorrhage (SAH) demands high healthcare resource utilization. Case fatality and disability remain as common outcomes of SAH. The purpose of this study was to perform a treatment cost-effectiveness analysis of patients with SAH.

Methods: We performed a long-term follow-up of the SAH patients treated in our institution over a 3-year period starting February 1998. Outcome 10 years after the SAH and treatment costs were evaluated. The health-related quality of life was evaluated using the EuroQol (EQ-5D) questionnaire and visual-analogue scale (VAS). The cost of a quality-adjusted life year (QALY) was calculated.

Results: Median follow-up time of the 178 patients was 10.8 years. Overall mortality rate was 24%. Of the 43 non-survivors, 42% died within 6 months. For the 135 survivors, the median EQ-5D index value was 1.00, which is similar to that for normal population. The median VAS value was 80, which is comparable to normal population's value. Of the survivors, 88% (119/135) were able to live at home and 63% (85/135) returned to work after SAH. The cost of neurosurgical treatment for one QALY was 1700€.

Conclusion: Long-term outcome of survivors after aneurysmal SAH was relatively good: most of them lived at home, 63% had returned to work and 36% were still working. The quality of life index of the survivors was similar to that of normal populations, and the survivors were as satisfied with their health as people in general are. Cost of neurosurgical treatment and cost of a QALY gained were acceptable.