Transcutaneous auricular vagus nerve stimulation reduces hospital cost of aneurysmal subarachnoid hemorrhage management: secondary analysis of the NAVSaH trial

Background: Aneurysmal subarachnoid hemorrhage (aSAH) accounts for only 5% of strokes in the United States but imposes substantial economic burdens on healthcare systems, with hospitalization costs exceeding $90,000 per patient. This study evaluated the economic implications of incorporating transcutaneous auricular vagus nerve stimulation (taVNS) into standard aSAH management.Methods: This was a secondary analysis of the Non-invasive Auricular Vagus nerve stimulation for Subarachnoid Hemorrhage (NAVSaH) trial, a single-center trial enrolling adult patients with spontaneous SAH, randomized 1:1 to receive either taVNS or sham stimulation. Cost data were sourced from institutional accounting databases. The primary economic outcomes included total hospitalization costs, resource utilization across service lines, and 30-day readmission rates. Cost and utilization analyses were stratified by Hunt and Hess grades and compared between the treatment arms.Results: The taVNS group (n=13) had lower 30-day hospitalization costs than the sham group (n=14) ($82,632 vs. $103,998, P=0.003), representing a 20.54% reduction. Resource utilization was lower in the taVNS than the sham group for multiple service areas, including respiratory (17.00 vs. 64.60 charges per patient, P=0.003), laboratory (112.23 vs. 140.36 charges per patient, P<0.001), and pharmacy services (266.54 vs 313.29 charges per patient, P=0.004). Additionally, the taVNS group had lower 30-day readmission rates (7.7% vs. 28.6%) and readmission costs ($2,716 vs. $13,085).Conclusion: This study provides preliminary evidence that taVNS reduces hospital costs and service utilization in patients with aSAH. Multicenter validation is warranted; however, these findings suggest that taVNS offers a novel strategy for improving resource utilization and costs in critical care settings.