Results from a new study show a greater than 90 percent probability that treating acute ischemic stroke patients with the clot-busting drug t-PA could result in a substantial net cost savings to the health care system. These savings are based on the fact that t-PA-treated stroke patients leave the hospital sooner and require less rehabilitation and nursing after discharge than do patients who do not receive t-PA. The study also showed that t-PA-treated stroke patients, because of their decreased disability, can expect to have an improved quality of life. These results, published in the April 1998 issue of Neurology, were reported by Susan Fagan, Pharm. D., Associate Professor of Pharmacy Practice at Wayne State University and Henry Ford Hospital. This study was sponsored by the National Institute of Neurological Disorders and Stroke (NINDS). (1)
Dr. Fagan estimated the costs per 1,000 patients eligible for treatment with t-PA compared with the costs per 1,000 stroke patients not treated with t-PA. The study used data from the NINDS t-PA Stroke Trial,(2) in which the average length of a hospital stay was shorter in t-PA-treated patients, 10.9 days, than in patients not treated with t-PA, 12.4 days. t-PA-treated patients were more frequently discharged to their home than to inpatient rehabilitation centers or nursing homes.
The cost of t-PA treatment increases hospital costs for patients when they are first admitted. However, because t-PA shortens hospital stays and decreases long-term disabilities, there is a net savings. For 1,000 t-PA patients, the researchers estimate an initial increase in hospital costs of $1.7 million, but an eventual savings of $4.8 million in nursing home care costs and $1.3 million in rehabilitation costs. The overall impact is a net decrease of more than $4 million in health care costs for every 1,000 patients treated.
"Considering that there are tens of thousands of stroke patients who could be eligible for t-PA, we are talking about a potential cost savings in excess of $100 million per year," said Michael D. Walker, M.D., Director of the Division of Stroke, Trauma, and Neurodegenerative Disorders at the NINDS.
"The use of t-PA for eligible patients with acute ischemic stroke appears to be a 'win-win' situation, with improved patient outcomes accompanied by a net cost savings to the health care system," said Dr. Fagan.
The NINDS t-PA Stroke Trial, which included more than 600 carefully selected stroke patients and was completed in December 1995, found that those treated with t-PA within the critical 3-hour time window of their initial stroke symptoms were at least 30 percent more likely than untreated patients to recover from their stroke with little or no disability.
"The good news about this study is the benefit it delivers both to the patient and the health care system in terms of long-term quality of life and realized cost savings," said Michael D. Walker, MD, Director of the Division of Stroke, Trauma and Neurodegenerative Disorders at the National Institute of Neurological Disorders and Stroke.
Each year about 700,000 Americans suffer a stroke. Stroke is the number one cause of adult disability in the United States, costing the nation more than $40 billion a year, and is the third leading cause of death.
The NINDS is the nation's principal supporter of research on the brain and nervous system and a lead agency for the Congressionally designated Decade of the Brain. The Institute supports and conducts a broad program of basic and clinical neurological investigations and is part of the National Institutes of Health, located in Bethesda, MD.
(1) Fagan, S.C.; Morgenstern, L.B.; Petitta, A.; Ward, R.E.; Tilley, B.C.; Marler, J.R.; Levine, S.R.; Broderick, J.P.; Kwiatkowski, T.G.; Frankel, M.; Brott, T.G.; Walker, M.D.; and the NINDS rt-PA Stroke Study Group. "Cost-effectiveness of Tissue Plasminogen Activator for Acute Ischemic Stroke." Neurology, Vol. 50, No. 4, April 1, 1998, p. 883.
(2) The National Institute of Neurological Disorders and Stroke t-PA Stroke Study Group. "Tissue Plasminogen Activator for Acute Ischemic Stroke." The New England Journal of Medicine, Vol. 333, No. 24, December 15, 1995, pp. 1581-1587.
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Neurology