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The Effect of tPA on Inpatient Rehabilitation after Stroke: A Cost Comparison

Published online by Cambridge University Press:  20 October 2014

Marina Richardson ,
Matthew Meyer  and
Robert Teasell
Marina Richardson*
Affiliation:
Lawson Health Research Institute
Matthew Meyer
Affiliation:
Lawson Health Research Institute Department of Epidemiology and Biostatistics, Western University
Robert Teasell
Affiliation:
Lawson Health Research Institute Department of Physical Medicine and Rehabilitation, Western University St. Joseph’s Health Care London, Parkwood Hospital, London, Ontario, Canada
*
Parkwood Hospital - B3019, 801 Commissioners Road East, London, Ontario, N6C 5J1, Canada. Email: Marina.Richardson@sjhc.london.on.ca.
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Abstract

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Background:

Tissue plasminogen activator has been found to significantly improve patient outcomes post stroke. Previous economic evaluations have adjusted for fewer admissions to inpatient rehabilitation but not for decreased length of stay in rehabilitation. Our objective was to estimate the potential cost savings associated with a decreased length of stay in inpatient rehabilitation for patients who receive tissue plasminogen activator compared to those who do not, in a Canadian context.

Methods:

Decreased length of stay in inpatient rehabilitation for patients who received tissue plasminogen activator compared to controls was reported previously in a population of 1962 patients admitted to hospital with an ischemic stroke in Ontario between July 1, 2003 and March 31, 2008. Average per diem cost savings associated with the use of tissue plasminogen activator were calculated using a literature based cost estimate. Sensitivity analysis varying the length of stay in inpatient rehabilitation was performed.

Results:

The estimated mean per diem cost of inpatient rehabilitation derived from the literature was $626. Based on previously reported estimates for reduced length of stay, receipt of tissue plasminogen activator was estimated to result in savings of $939 per patient during inpatient rehabilitation. Sensitivity analysis suggested that these cost savings could range from $501 to $1377 per patient on average.

Conclusions:

Future economic evaluations of tissue plasminogen activator should consider adjusting for shortened length of stay in inpatient rehabilitation for patients who receive tissue plasminogen activator.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 41 , Issue 4 , July 2014 , pp. 482 - 485
Copyright
Copyright © The Canadian Journal of Neurological 2014

References

1.Mukherjee, D, Patil, CG.Epidemiology and the global burden of stroke. World Neurosurg. 2011;76(6 Suppl):S85–90.CrossRefGoogle ScholarPubMed
2.Hirsch, JA, Yoo, AJ, Nogueira, RG, et al. Case volumes of intra-arterial and intravenous treatment of ischemic stroke in the USA. J Neurointerv Surg. 2009;1(1):27–31.CrossRefGoogle ScholarPubMed
3.Canadian Stroke Network. Canadian Stroke Network [homepage on the Internet]. Ottawa: Canadian Stroke Network; 2011. The quality of stroke care in Canada; 2011 [cited 2013 Jan 7]. Available from: http://www.canadianstrokenetwork.ca/wpcontent/uploads/2011/06/QoSC-EN1.pdf.Google Scholar
4.Wardlaw, JM, Murray, V, Berge, E, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: An updated systematic review and meta-analysis. Lancet. 2012;379(9834):2364–72.CrossRefGoogle ScholarPubMed
5.Jung, KT, Shin, DW, Lee, KJ, Oh, M.Cost-effectiveness of recombinant tissue plasminogen activator in the management of acute ischemic stroke: a systematic review. J Clin Neurol. 2010;6 (3):117–26.CrossRefGoogle ScholarPubMed
6.Fagan, SC, Morgenstern, LB, Petitta, A, et al. Cost-effectiveness of tissue plasminogen activator for acute ischemic stroke. Ninds rt-pa stroke study group. Neurology. 1998;50(4):883–90.Google ScholarPubMed
7.Sinclair, SE, Frighetto, L, Loewen, PS, et al. Cost-utility analysis of tissue plasminogen activator therapy for acute ischaemic stroke: A Canadian healthcare perspective. Pharmacoeconomics. 2001;19(9):927–36.CrossRefGoogle ScholarPubMed
8.Demaerschalk, BM, Hwang, HM, Leung, G.Cost analysis review of stroke centers, telestroke, and rt-pa. Am J Manag Care. 2010;16(7):537–44.Google ScholarPubMed
9.Dewey, HM, Thrift, AG, Mihalopoulos, C, et al. Cost of stroke in Australia from a societal perspective: Results from the north east melbourne stroke incidence study (nemesis). Stroke. 2001;32(10):2409–16.CrossRefGoogle Scholar
10.Araujo, DV, Teich, V, Passos, RB, Martins, SC.Analysis of the cost-effectiveness of thrombolysis with alteplase in stroke. Arq Bras Cardiol. 2010;95(1):12–20.Google ScholarPubMed
11.Boudreau, DM, Guzauskas, G, Villa, KF, Fagan, SC, Veenstra, DL.A model of cost-effectiveness of tissue plasminogen activator in patient subgroups 3 to 4.5 hours after onset of acute ischemic stroke. Ann Emerg Med. 2013;61(1):46–55.CrossRefGoogle Scholar
12.Chambers, MG, Koch, P, Hutton, J.Development of a decision-analytic model of stroke care in the United States and Europe. Value Health. 2002;5(2):82–97.CrossRefGoogle ScholarPubMed
13.Dirks, M, Baeten, SA, Dippel, DW, et al. Real-life costs and effects of an implementation program to increase thrombolysis in stroke. Neurology. 2012;79(6):508–14.CrossRefGoogle ScholarPubMed
14.Earnshaw, SR, Jackson, D, Farkouh, R, Schwamm, L.Cost-effectiveness of patient selection using penumbral-based MRI for intravenous thrombolysis. Stroke. 2009;40(5):1710–20.CrossRefGoogle ScholarPubMed
15.Ehlers, L, Muskens, WM, Jensen, LG, Kjolby, M, Andersen, G.National use of thrombolysis with alteplase for acute ischaemic stroke via telemedicine in Denmark: A model of budgetary impact and cost effectiveness. CNS Drugs. 2008;22(1):73–81.CrossRefGoogle Scholar
16.Ehlers, L, Andersen, G, Clausen, LB, Bech, M, Kjolby, M.Cost-effectiveness of intravenous thrombolysis with alteplase within a 3-hour window after acute ischemic stroke. Stroke. 2007;38(1):85–9.CrossRefGoogle ScholarPubMed
17.Mar, J, Begiristain, JM, Arrazola, A.Cost-effectiveness analysis of thrombolytic treatment for stroke. Cerebrovasc Dis. 2005;20(3):193–200.CrossRefGoogle ScholarPubMed
18.Moodie, ML, Carter, R, Mihalopoulos, C, et al. Trial application of a model of resource utilization, costs, and outcomes for stroke (morucos) to assist priority setting in stroke. Stroke. 2004;35(5):1041–6.CrossRefGoogle Scholar
19.Sandercock, P, Berge, E, Dennis, M, et al. Cost-effectiveness of thrombolysis with recombinant tissue plasminogen activator for acute ischemic stroke assessed by a model based on UK NHS costs. Stroke. 2004;35(6):1490–7.CrossRefGoogle Scholar
20.Stahl, JE, Furie, KL, Gleason, S, Gazelle, GS.Stroke: Effect of implementing an evaluation and treatment protocol compliant with ninds recommendations. Radiology. 2003;228(3):659–68.CrossRefGoogle ScholarPubMed
21.Tung, CE, Win, SS, Lansberg, MG.Cost-effectiveness of tissue-type plasminogen activator in the 3- to 4.5-hour time window for acute ischemic stroke. Stroke. 2011;42(8):2257–62.CrossRefGoogle Scholar
22.Meyer, M, Murie-Fernandez, M, Hall, R, et al. Assessing the impact of thrombolysis on progress through inpatient rehabilitation after stroke: A multivariable approach. Int J Stroke. 2012;7(6):460–4.CrossRefGoogle ScholarPubMed
23.Mittmann, N, Seung, SJ, Hill, MD, et al. Impact of disability status on ischemic stroke costs in Canada in the first year. Can J Neurol Sci. 2012;39(6):793–800.CrossRefGoogle ScholarPubMed
24.Chambers, M, Hutton, J, Gladman, J.Cost-effectiveness analysis of antiplatelet therapy in the prevention of recurrent stroke in the UK. Aspirin, dipyridamole and aspirin - dipyridamole. Pharmacoeconomics. 1999;16(5 Pt 2):577–93.CrossRefGoogle ScholarPubMed