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(Stroke. 2006;37:943.)
© 2006 American Heart Association, Inc.

Letters to the Editor

Economic Benefit of Increasing Utilization of Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke in the United States

Phillip A. Scott, MD Robert Silbergleit, MD

Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

We read with interest the sensitivity analysis on the US economic benefit possible from increasing utilization of tissue plasminogen activator in acute stroke by Demaerschalk et al.¹

While there are several issues of concern affecting its validity, we believe their analysis seriously under-represented the present dollar value of the savings by using a reference value of (–)$600 per patient from 1996. After adjusting for the annual effect of inflation using US Bureau of Labor Statistics Consumer Price Index data, the actual per treated patient savings is 24% greater, or (–)$745 per patient, in 2005. Using this figure, the best estimate of cost savings in the first year poststroke ranges from 9 to >90 million dollars, with similar changes in the 95% CI limits, depending on the proportion of patients receiving tissue plasminogen activator (see Table below for cost savings per treatment %).

View this table: [in this window] [in a new window]   Estimated US First-Year Post-Stroke Cost Savings by Proportion of Patients Receiving tPA

1. Demaerschalk BM, Yip TR. Economic benefit of increasing utilization of intraveneous tissue plasminogen activator for acute ischemic stroke in the United States. Stroke. 2005; 36: 2500–2503.[Abstract/Free Full Text]

Bart M. Demaerschalk, MD, MSc, FRCPC

Divisions of Cerebrovascular Diseases and Critical Care Neurology, Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, Arizona

Todd R. Yip, MD, MSc

Department of Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, SK, Canada

Response:

Drs Scott and Silbergleit are correct that our estimates of economic benefit of increasing utilization of intravenous tissue plasminogen activator (tPA) for acute stroke in the US¹ do not reflect current day savings because our reference values came from 1996 cost data published in 1998.² Unfortunately, this remains the most current US cost-effectiveness study available for tPA in stroke.

By using the US Department of Labor Bureau of Labor Statistics Consumer Price Index (CPI) inflation calculator (www.bls.gov) to adjust for inflation (reference year 1996 and recent year 2005), the net cost after . . . [Full Text of this Article]

This article has been cited by other articles:

				T. R. Yip and B. M. Demaerschalk Estimated Cost Savings of Increased Use of Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke in Canada Stroke, June 1, 2007; 38(6): 1952 - 1955. [Abstract] [Full Text] [PDF]