Systematic Review of Direct Hospital Costs Associated with Aneurysmal Subarachnoid Hemorrhage Management

Aneurysmal subarachnoid hemorrhage (aSAH) is a severe condition associated with significant morbidity, mortality, and disability. In-hospital care of aSAH is complex and resource intensive, posing substantial financial challenges to health care systems. To support efficient resource allocation, health policy decision-making, and care optimization, this systematic review aimed to assess and synthesize literature on direct in-hospital costs of aSAH management.

A comprehensive search was performed in July 2025 across PubMed, Medline, Web of Science, Cochrane Library, Emcare, Embase (Ovid), and PsycINFO to identify studies reporting direct in-hospital costs related to aSAH. Reporting completeness and risk of bias were assessed using the Consolidated Health Economic Evaluation Reporting Standards 2022 and the Joanna Briggs Institute checklists. Reported costs were narratively synthesized and converted to 2024 US dollars using the CCEMG-EPPI-Centre Cost Converter. In addition, a random-effects meta-analysis was conducted to compare in-hospital costs between surgical clipping and endovascular coiling.

The database search identified 1,591 articles, of which 30 were included. The average reporting completeness was 74% (range 46-91%) and methodological quality 76% (range 41-100%). Reported in-hospital costs ranged from $11,884 to $459,579 (median $68,711), being the highest in North America, followed by Europe and Asia. Costs as a percentage of gross domestic product per capita ranged from 35 to 639%. Key cost drivers included length of stay, clinical severity, and complications. The meta-analysis found no significant cost difference between clipping and coiling (mean difference $3,057, 95% confidence interval -$11,597 to $17,710).

In-hospital costs for aSAH management are substantial and vary widely due to differences in health care systems, study methodology, and clinical practices. The quality of economic evaluations remains inconsistent, underscoring the need for more standardized and transparent methodologies. As global health care spending increases, high-quality economic evidence is essential for equitable and sustainable care.