Abstract 3057: Increased rt-PA Utilization Will Decrease Healthcare Costs in SC
Recombinant tissue plasminogen activator (rt-PA) has been approved for acute ischemic stroke (AIS) patients since 1996. An early (1998) paper reported net financial and health benefits from its use, but we are aware of no reports of economic impacts of rt-PA use in todays healthcare system. We used a Markov model to estimate the expected current economic and health benefits of rt-PA use for the state of South Carolina.
We compared expected cost for all stroke hospital admission for patients treated with rt-PA at the current rate (3%) of rt-PA use to the stroke costs if the treatment rate increased to 20% of all stroke admissions. We estimated total stroke costs for a five year time period (2012 through 2016). The Markov model used the original rt-PA trial data for estimation of expected outcomes based on the modified Rankin Scale (mRS) of disability at discharge. Health benefits are measured using quality-adjusted life years (QALYs), and the economic impacts are estimated cost to treat a patient based on cost for SC hospital discharges and other stroke care. Costs are reported in 2010 currency. Inflationary factors and economic discounting is not employed for the budget impacts reported here.Assumptions in the model include the rate of recurrent stroke (.052), rate of symptomatic hemorrhage after rt-PA (6.45%), the inclusion of charge for a two hour specialist fee during initial evaluation, patients discharged to a nursing home remain there until death, subsequent strokes do not receive rt-PA, those discharged from rehabilitation went to a nursing home. Patients were assumed to have a median age of 67 years at the time of the stroke. Cost of rt-PA was $2750 for 100mg. A CDC AIS-specific death rate was assumed.
We predicted a total cost of care for stroke in SC for 2012 through 2016 of $2,531,398,032 if rt-PA use continues at a rate of 3%. However, if the rate increases to 20% we will save $16,615,723 in stroke care cost over 5 years. Thus, given the current cost of AIS and the benefits documented for rt-PA treatment, concerted efforts to increase rt-PA use in SC may be expected to save money for payers in addition to improving quality of life for many stroke survivors.
- © 2012 by American Heart Association, Inc.