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Updated: Jun 20, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Short- and Long-term Health Care Resource Utilization and Costs Following Intracerebral Hemorrhage
Shannon M Fernando1, Danial Qureshi2, Robert Talarico2
1From the Division of Critical Care (S.M.F., S.W.E., K.K.), Department of Medicine, and Department of Emergency Medicine (S.M.F.), University of Ottawa; ICES (D.Q., R.T., M.M.S., D.C.S., P.T.), Toronto; Clinical Epidemiology Program (D.Q., R.T., D.D., M.M.S., S.W.E., P.T., K.K.), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (D.Q., D.D., M.M.S., S.W.E., P.T.), University of Ottawa; Bruyère Research Institute (D.Q., P.T.); Division of Palliative Care (D.Q., P.T., K.K.), Department of Medicine, Division of Neurology (D.D.), Department of Medicine, and Division of Nephrology (M.M.S.), Department of Medicine, University of Ottawa, Ontario; Calgary Stroke Program (E.E.S., M.D.H.), Hotchkiss Brain Institute, and Department of Clinical Neurosciences (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, Alberta; Interdepartmental Division of Critical Care Medicine (V.A.M., D.C.S.), University of Toronto; Krembil Research Institute (V.A.M.), Toronto Western Hospital, University Health Network; Department of Critical Care Medicine (V.A.M., D.C.S.), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (D.C.S.), St. Michael's Hospital, Toronto; Department of Medicine (B.R.), Division of Critical Care and Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton; and Institut du Savoir Montfort (K.K.), Ottawa, Ontario, Canada. sfernando@qmed.ca.
Insights
Intracerebral hemorrhage (ICH) incurs substantial healthcare costs, exceeding $120 million annually in Ontario. Survivors face higher costs than deceased patients, and oral anticoagulation (OAC) use is linked to increased spending.
Area of Science:
- Neurology
- Health Economics
- Public Health
Background:
- Intracerebral hemorrhage (ICH) represents a significant cause of mortality and morbidity.
- Understanding the associated healthcare resource utilization and costs is crucial for effective healthcare management.
- Oral anticoagulation (OAC) use in patients with ICH requires careful consideration regarding its impact on healthcare expenditures.
Purpose of the Study:
- To evaluate the short- and long-term resource use and costs associated with intracerebral hemorrhage (ICH) in a population-based cohort.
- To assess the association between oral anticoagulation (OAC) use and healthcare costs in patients with ICH.
Main Methods:
- Retrospective cohort study of adult patients (≥18 years) with ICH in Ontario, Canada (2009-2017).
- Data linkage with health administrative databases to capture outcomes and costs.
- Generalized linear models used to identify factors associated with total cost; OAC analysis limited to patients ≥66 years.
Main Results:
- The study included 16,248 individuals with ICH; 1-year mortality was 46.0%.
- Median total 1-year healthcare costs were $26,886, with significantly higher costs for survivors ($44,969) versus deceased patients ($7,268).
- Oral anticoagulation (OAC) use was associated with increased total 1-year costs (cost ratio 1.06). Total annual costs exceeded $120 million.
Conclusions:
- Intracerebral hemorrhage (ICH) is associated with substantial healthcare costs, approximately 10 times the median inpatient cost in Ontario.
- Costs are higher for survivors compared to deceased patients, highlighting the long-term economic burden.
- Oral anticoagulation (OAC) use is independently associated with increased healthcare costs, necessitating strategies to reduce disability and improve cost-effectiveness.
Objective:
We sought to evaluate the short- and long-term resource use and costs associated with intracerebral hemorrhage (ICH) taken from an entire population. We in addition sought to evaluate the association of oral anticoagulation (OAC) and health care costs.
Methods:
This was a retrospective cohort study of adult patients (≥18 years) with ICH in the entire population of Ontario, Canada (2009-2017). We captured outcomes through linkage to health administrative databases. We used generalized linear models to identify factors associated with total cost. Analysis of OAC use was limited to patients ≥66 years of age. The primary outcome was total 1-year direct health care costs in 2020 US dollars.
Results:
Among 16,248 individuals with ICH (mean age 71.2 years, male 52.3%), 1-year mortality was 46.0%, and 24.2% required mechanical ventilation. The median total 1-year cost was $26,886 (interquartile range [IQR] $9,641-$62,907) with costs for those who died in hospital of $7,268 (IQR $4,031-$14,966) vs $44,969 (IQR $20,264-$82,414, p < 0.001) for survivors to discharge. OAC use (analysis limited to individuals ≥66 years old) was associated with higher total 1-year costs (cost ratio 1.06 [95% confidence interval 1.01-1.11]). Total 1-year costs for the entire cohort exceeded $120 million per year over the study period.
Conclusions:
ICH is associated with significant health care costs, and the median cost of a patient with ICH is roughly 10 times the median inpatient cost in Ontario. Costs were higher among survivors than deceased patients. OAC use is independently associated with increased costs. To maximize cost-effectiveness, future therapies for ICH must aim to reduce disability, not only improve mortality.
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