Progressive hydrocephalus is a serious complication in patients with aneurysmal subarachnoid hemorrhage. The choice between adjustable or nonadjustable pressure shunts for the treatment of this type of hydrocephalus remains difficult to define. The variability of intracranial pressure adds to the difficulty in choosing the best treatment. Numerous clinical studies have shown that adjustable pressure shunts have shown advantages in reducing problems with the shunt system, but they are three times more expensive than non-adjustable shunts. A study conducted by scholars in neurosurgery at the National Institute of Neurosciences in Singapore suggests that the odds of needing a revision of an adjustable pressure shunt are lower, offering a higher overall cost effectiveness. The study included all patients with hydrocephalus secondary to aneurysmal subarachnoid hemorrhage who underwent ventriculoperitoneal shunts between 2006 and 2012. Patients were divided into a pressure-adjustable shunt group and a non-pressure-adjustable shunt group. The rate of shunt revision, the reasons for adjustment of the shunt device in patients with adjustable pressure shunts, and the effectiveness of adjustment were analyzed separately. In addition, a cost-effectiveness analysis was performed to determine whether the overall cost of the adjustable shunts exceeded that of the non-adjustable shunts. The results of the study showed that 94 patients with hydrocephalus secondary to aneurysmal subarachnoid hemorrhage underwent ventriculoperitoneal shunts. Of these patients, 37 had non-adjustable shunts placed, while 54 had adjustable shunts placed. Four of 57 patients with adjustable shunts received shunt revisions compared with 8 of 37 patients (21.6%) with nonadjustable shunts, and 4 of 8 patients with shunt revisions received adjustable shunts. Thirty-three of the 57 patients with adjustable shunts underwent shunt adjustment. The reason for adjustment was a trial of functional improvement (n = 21), excessive shunt (n = 5), inadequate shunt (n = 6), or excessive depression of the skull defect (n = 1). Twenty-four of these 33 patients showed improvement in neurological function. Cost-effectiveness analysis showed an average savings of $646.60 per patient with adjustable shunts, as the cost of shunt revision was much higher than the cost of adjustable shunts. Adjustable shunts allow for non-invasive adjustment of pressure settings after problems with the shunt system, thereby avoiding the need for shunt revision. The results also show that patients with adjustable shunts are less likely to undergo shunt revision and are therefore more cost-effective. In addition, the shunt adjustments made in patients with adjustable shunts also resulted in better neurological outcomes. This study is of great clinical relevance for our developing countries, where patient affordability is low. It is worth promoting its use in patients with hydrocephalus secondary to aneurysmal subarachnoid hemorrhage. Further expansion of the study is also worthwhile in the treatment of other hydrocephalus.