Cost-effectiveness of emergency intraarterial intracerebral thrombolysis: a pilot study.
OBJECTIVE
To assess the clinical efficacy and cost-effectiveness of emergency thrombolysis as a treatment strategy for thromboembolic intracerebral events.


METHODS
Thirty-four patients with symptoms suggestive of middle cerebral artery occlusion were included. Eight of these patients were treated with intraarterial urokinase. Effectiveness was determined by comparing the admission National Institutes of Health stroke score to the 24-hour National Institutes of Health stroke score. The cost and length of stay of both populations were derived and used as measures of direct cost. The likelihood of admission to extended care facilities and estimated length cost of admission was used as a measure of indirect cost.


RESULTS
The control population became slightly worse, with a change in National Institutes of Health score of -0.5, whereas the treated population improved slightly, with a change in National Institutes of Health score of +5.12. Analysis of the direct costs data between the two populations revealed a slight increased mean for the treated population ($15,202) as compared with the control population ($13,478). The unpaired t test, however, revealed no significant cost difference between the two groups. By reducing the number of completed strokes by one third or by decreasing the severity by the same factor (as shown in our study), the likelihood of admission to an extended nursing facility also is decreased. The cost saving per patient from extended care facilities is approximately $3435.


CONCLUSIONS
The emergency application of intraarterial thrombolysis with urokinase results in a statistically significant positive change in National Institutes of Health score by at least five points. A statistically significant benefit is realized through the use of intraarterial urokinase. A statistically insignificant additional cost is shown by this study. This insignificant cost is more than offset by the saved nursing home costs.
Lanzieri
C F
CF
Department of Radiology, University Hospitals of Cleveland, Ohio 44106, USA.
Tarr
R W
RW
Landis
D
D
Selman
W R
WR
Lewin
J S
JS
Adler
L P
LP
Silvers
J B
JB
D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy / Q000191:economics; D002544:Cerebral Infarction / Q000188:drug therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004630:Emergencies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D005500:Follow-Up Studies; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000188:drug therapy* / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000187:drug effects; D010865:Pilot Projects; D012866:Skilled Nursing Facilities / Q000191:economics; D015912:Thrombolytic Therapy / Q000191:economics*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics
D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator