Kit N Simpson1, Annie N Simpson2, Patrick D Mauldin2, Michael D Hill2, Sharon D Yeatts2, Judith A Spilker2, Lydia D Foster2, Pooja Khatri2, Renee Martin2, Edward C Jauch2, Dawn Kleindorfer2, Yuko Y Palesch2, Joseph P Broderick2. 1. From the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Academic Health Center, OH (J.P.B., D.K., P.K., J.A.S.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (M.D.H.); and Department of Healthcare Leadership and Management (K.N.S., A.N.S.), Department of General Internal Medicine (P.D.M.), Department of Public Health Sciences (S.D.Y., L.D.F., R.M., Y.Y.P.), Department of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston. simpsonk@musc.edu. 2. From the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Academic Health Center, OH (J.P.B., D.K., P.K., J.A.S.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (M.D.H.); and Department of Healthcare Leadership and Management (K.N.S., A.N.S.), Department of General Internal Medicine (P.D.M.), Department of Public Health Sciences (S.D.Y., L.D.F., R.M., Y.Y.P.), Department of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston.
Abstract
BACKGROUND AND PURPOSE: The Interventional Management of Stroke (IMS) III study tested the effect of intravenous tissue-type plasminogen activator (tPA) alone when compared with intravenous tPA followed by endovascular therapy and collected cost data to assess the economic implications of the 2 therapies. This report describes the factors affecting the costs of the initial hospitalization for acute stroke subjects from the United States. METHODS: Prospective cost analysis of the US subjects was treated with intravenous tPA alone or with intravenous tPA followed by endovascular therapy in the IMS III trial. Results were compared with expected Medicare payments. RESULTS: The adjusted cost of a stroke admission in the study was $35 130 for subjects treated with endovascular therapy after intravenous tPA treatment and $25 630 for subjects treated with intravenous tPA alone (P<0.0001). Significant factors related to costs included treatment group, baseline National Institutes of Health Stroke Scale, time from stroke onset to intravenous tPA, age, stroke location, and comorbid diabetes mellitus. The mean cost for subjects who had routine use of general anesthesia as part of endovascular therapy was $46 444 when compared with $30 350 for those who did not have general anesthesia. The costs of embolectomy for IMS III subjects and patients from the National Inpatient Sample cohort exceeded the Medicare diagnosis-related group payment in ≥75% of patients. CONCLUSIONS: Minimizing the time to start of intravenous tPA and decreasing the use of routine general anesthesia may improve the cost-effectiveness of medical and endovascular therapy for acute stroke. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00359424.
RCT Entities:
BACKGROUND AND PURPOSE: The Interventional Management of Stroke (IMS) III study tested the effect of intravenous tissue-type plasminogen activator (tPA) alone when compared with intravenous tPA followed by endovascular therapy and collected cost data to assess the economic implications of the 2 therapies. This report describes the factors affecting the costs of the initial hospitalization for acute stroke subjects from the United States. METHODS: Prospective cost analysis of the US subjects was treated with intravenous tPA alone or with intravenous tPA followed by endovascular therapy in the IMS III trial. Results were compared with expected Medicare payments. RESULTS: The adjusted cost of a stroke admission in the study was $35 130 for subjects treated with endovascular therapy after intravenous tPA treatment and $25 630 for subjects treated with intravenous tPA alone (P<0.0001). Significant factors related to costs included treatment group, baseline National Institutes of Health Stroke Scale, time from stroke onset to intravenous tPA, age, stroke location, and comorbid diabetes mellitus. The mean cost for subjects who had routine use of general anesthesia as part of endovascular therapy was $46 444 when compared with $30 350 for those who did not have general anesthesia. The costs of embolectomy for IMS III subjects and patients from the National Inpatient Sample cohort exceeded the Medicare diagnosis-related group payment in ≥75% of patients. CONCLUSIONS: Minimizing the time to start of intravenous tPA and decreasing the use of routine general anesthesia may improve the cost-effectiveness of medical and endovascular therapy for acute stroke. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00359424.
Authors: Gregory F Guzauskas; Denise M Boudreau; Kathleen F Villa; Steven R Levine; David L Veenstra Journal: Stroke Date: 2012-04-25 Impact factor: 7.914
Authors: Hans Krueger; Patrice Lindsay; Robert Cote; Moira K Kapral; Janusz Kaczorowski; Michael D Hill Journal: Stroke Date: 2012-05-24 Impact factor: 7.914
Authors: Nicole Mittmann; Soo Jin Seung; Michael D Hill; Stephen J Phillips; Vladimir Hachinski; Robert Coté; Brian H Buck; Ariane Mackey; David J Gladstone; David C Howse; Ashfaq Shuaib; Mike Sharma Journal: Can J Neurol Sci Date: 2012-11 Impact factor: 2.104
Authors: Aquilla S Turk; John M Campbell; Alejandro Spiotta; Jan Vargas; Raymond D Turner; M Imran Chaudry; Holly Battenhouse; Christine A Holmstedt; Edward Jauch Journal: J Neurointerv Surg Date: 2013-02-01 Impact factor: 5.836
Authors: Joseph P Broderick; Yuko Y Palesch; Andrew M Demchuk; Sharon D Yeatts; Pooja Khatri; Michael D Hill; Edward C Jauch; Tudor G Jovin; Bernard Yan; Frank L Silver; Rüdiger von Kummer; Carlos A Molina; Bart M Demaerschalk; Ronald Budzik; Wayne M Clark; Osama O Zaidat; Tim W Malisch; Mayank Goyal; Wouter J Schonewille; Mikael Mazighi; Stefan T Engelter; Craig Anderson; Judith Spilker; Janice Carrozzella; Karla J Ryckborst; L Scott Janis; Renée H Martin; Lydia D Foster; Thomas A Tomsick Journal: N Engl J Med Date: 2013-02-07 Impact factor: 91.245
Authors: Werner Hacke; Geoffrey Donnan; Cesare Fieschi; Markku Kaste; Rüdiger von Kummer; Joseph P Broderick; Thomas Brott; Michael Frankel; James C Grotta; E Clarke Haley; Thomas Kwiatkowski; Steven R Levine; Chris Lewandowski; Mei Lu; Patrick Lyden; John R Marler; Suresh Patel; Barbara C Tilley; Gregory Albers; Erich Bluhmki; Manfred Wilhelm; Scott Hamilton Journal: Lancet Date: 2004-03-06 Impact factor: 79.321
Authors: Gregg C Fonarow; Wenqin Pan; Jeffrey L Saver; Eric E Smith; Mathew J Reeves; Joseph P Broderick; Dawn O Kleindorfer; Ralph L Sacco; DaiWai M Olson; Adrian F Hernandez; Eric D Peterson; Lee H Schwamm Journal: JAMA Date: 2012-07-18 Impact factor: 56.272
Authors: Ramon Luengo-Fernandez; Louise E Silver; Sergei A Gutnikov; Alastair M Gray; Peter M Rothwell Journal: Value Health Date: 2013-01-11 Impact factor: 5.725
Authors: Xuanqian Xie; Anna Lambrinos; Brian Chan; Irfan A Dhalla; Timo Krings; Leanne K Casaubon; Cheemun Lum; Nancy Sikich; Aditya Bharatha; Vitor Mendes Pereira; Grant Stotts; Gustavo Saposnik; Christina O'Callaghan; Linda Kelloway; Michael D Hill Journal: CMAJ Open Date: 2016-06-16
Authors: Alex Abou-Chebl; Sharon D Yeatts; Bernard Yan; Kevin Cockroft; Mayank Goyal; Tudor Jovin; Pooja Khatri; Phillip Meyers; Judith Spilker; Rebecca Sugg; Katja E Wartenberg; Tom Tomsick; Joe Broderick; Michael D Hill Journal: Stroke Date: 2015-07-02 Impact factor: 7.914
Authors: Annie N Simpson; Jillian B Harvey; Steven M DiLembo; Ellen Debenham; Christine A Holmstedt; Cory O Robinson; Kit N Simpson; Eyad Almallouhi; Dee W Ford Journal: Telemed J E Health Date: 2020-02-11 Impact factor: 3.536
Authors: C D Streib; S Rangaraju; D T Campbell; D G Winger; S L Paolini; A J Zhang; B T Jankowitz; A P Jadhav; T G Jovin Journal: AJNR Am J Neuroradiol Date: 2018-12-27 Impact factor: 3.825
Authors: Kit N Simpson; Annie N Simpson; Patrick D Mauldin; Yuko Y Palesch; Sharon D Yeatts; Dawn Kleindorfer; Thomas A Tomsick; Lydia D Foster; Andrew M Demchuk; Pooja Khatri; Michael D Hill; Edward C Jauch; Tudor G Jovin; Bernard Yan; Rüdiger von Kummer; Carlos A Molina; Mayank Goyal; Wouter J Schonewille; Mikael Mazighi; Stefan T Engelter; Craig Anderson; Judith Spilker; Janice Carrozzella; Karla J Ryckborst; L Scott Janis; Joseph P Broderick Journal: J Am Heart Assoc Date: 2017-05-08 Impact factor: 5.501