Abstract W P289: Cost Burden of Stroke Mimics and Transient Ischemic Attacks Following Intravenous Tissue Plasminogen Activator Treatment
Objective: The decision to treat a patient with acute stroke symptoms is based on pertinent history, brief neurological examination, urgent labs, and head CT. In this setting, patients with stroke mimic (SM) may mistakenly receive IV-tPA. The main goal of this study was to investigate the excess direct and indirect hospital costs among patients who received IV-tPA when the final diagnosis was not ischemic stroke.
Method: We reviewed the records of 538 IV-tPA treated patients who presented to our primary stroke centers. The excess cost analysis compared the actual direct and indirect hospital costs of an individual patient to what their direct and indirect hospital costs would have been had they primarily been diagnosed with SM or TIA. We obtained the actual and itemized direct and indirect hospital costs of each patient who had a diagnosis of SM or TIA. We determined the ‘calculated cost’ for each patient based on the projected direct and indirect hospital costs associated with each patient’s actual diagnosis, symptoms, severity of disease, other active clinical problems, and hospital course.
Results: Seventy-four of 538 post IV-tPA patients had final diagnosis of SM and 21 had TIA. The excess direct and indirect hospital costs for SM was $257,975 and $152,813, respectively. The median excess cost was $5,401 per admission. The excess total cost for TIA was $85,026 with a median of $3,407 per admission. Considering the 2013 Wage Index report for Memphis, TN (WI: ∿ 0.93), and a 42% rate of direct personnel cost in our direct cost analysis, we can estimate that, in the United States, the excess direct hospital cost associated with administration of IV-tPA to patients with SM is approximately 15 million dollars per year with an average hospital direct cost of $3600 per admission.
Conclusion: Our study reveals that administration of IV-tPA to patients with SM is associated with significant excess cost; mainly from the cost of unnecessary hospital admission, IV-tPA, and higher level of care.
Author Disclosures: N. Goyal: None. S. Male: None. S. Bellamkonda: None. R. Zand: None.
- © 2015 by American Heart Association, Inc.