Transcutaneous Auricular Vagus Nerve Stimulation Reduces Hospital Cost of Aneurysmal Subarachnoid Hemorrhage Management: Secondary Analysis of the NAVSaH Trial

Background/Objective : Aneurysmal subarachnoid hemorrhage (aSAH) imposes substantial economic burdens on healthcare systems, with average 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 is a secondary analysis of the Non-invasive Auricular Vagus nerve stimulation for Subarachnoid Hemorrhage (NAVSaH) trial, a prospective, triple-blinded, randomized controlled trial. The trial was conducted at a single academic medical center and enrolled adult patients with spontaneous SAH, who were subsequently randomized 1:1 to receive either taVNS or sham stimulation. Cost data were sourced from institutional databases and disaggregated by functional areas. Primary economic outcomes included total hospitalization costs, resource utilization across service lines, and 30-day readmission rates. Cost analyses were stratified by Hunt and Hess grades, and daily healthcare resource utilization was evaluated using Kolmogorov-Smirnov tests. Results : The taVNS treatment group (n=13) demonstrated significantly lower 30-day hospitalization costs compared to the control group (n=14) ($82,632.62 vs. $103,998, p=0.003), representing a 20% reduction in costs. The taVNS group had a trend of lower 30-day readmission rate (7.7% vs. 28.6%, p=0.08) with lower readmission costs ($2,716 vs. $13,085 mean cost). Resource utilization was significantly lower in the taVNS group across multiple categories, including respiratory services (17 vs. 64.60 charges per patient, p<0.001), laboratory services (112.23 vs. 140 charges per patient, p<0.001), pharmacy (266.54 vs 313.29 charges per patient, p<0.001), and room & board (5.08 vs 8.64 charges per patient, p=0.002). Conclusions : This study demonstrates that taVNS significantly reduces modifiable hospitalization costs and 30-day readmission costs in aSAH patients. While multicenter validation is warranted, these findings provide early evidence that taVNS could represent an important approach to reducing healthcare costs through targeted neuromodulation, offering a novel strategy for improving both clinical outcomes, resource utilization and financial sustainability in critical care settings. Trial Registration: NCT, NCT04557618. Registered 4 September 2020, https://clinicaltrials.gov/study/NCT04557618