Hospital-based financial analysis of endovascular therapy and intravenous thrombolysis for large vessel acute ischemic strokes: the 'bottom line'.
BACKGROUND
Economic viability is important to any hospital striving to be a comprehensive stroke center. An inability to recover cost can strain sustained delivery of advanced stroke care.


OBJECTIVE
To carry out a comparative financial analysis of intravenous (IV) recombinant tissue plasminogen activator and endovascular (EV) therapy in treating large vessel strokes from a hospital's perspective.


METHODS
Actual hospital's charges, costs, and payments were analyzed for 265 patients who received treatment for large vessel strokes. The patients were divided into an EV (n=141) and an IV group (n=124). The net gain/loss was calculated as the difference between payments received and the total cost.


RESULTS
The charges, costs, and payments were significantly higher for the EV than the IV group (p<0.0001 for all). Medicare A was the main payer. Length of stay was inversely related to net gain/loss (p<0.0001). Favorable outcome was associated with a net gain of $3853 (±$21,155) and poor outcome with a net deficit of $2906 (±$15,088) (p=0.003). The hospital showed a net gain for the EV group versus a net deficit for the IV group in patients who survived the admission (p=0.04), had a favorable outcome (p=0.1), or were discharged to home (p=0.03). There was no difference in the time in hospital based on in-hospital mortality for the EV group but patients who died in the IV group had a significantly shorter length of stay than those who survived (p=0.04). The favorable outcome of 42.3% in the EV group was significantly higher than the 29.4% in the IV group (p=0.03).


CONCLUSIONS
Endovascular therapy was associated with better outcomes and higher cost-recovery than IV thrombolysis in patients with large vessel strokes.
Department of Radiology and Neurosurgery and Neurology, West Virginia University Healthcare, Morgantown, West Virginia, USA.
Ansaar T
AT
Rai
Decision Support West Virginia University Healthcare, Morgantown, West Virginia, USA.
Kim
K
Evans
D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000191:economics* / Q000628:therapy; D003365:Costs and Cost Analysis / Q000191:economics* / Q000379:methods; D057510:Endovascular Procedures / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000191:economics* / Q000628:therapy; D015912:Thrombolytic Therapy / Q000191:economics*; D016896:Treatment Outcome
Economics; Stroke; Thrombectomy; Thrombolysis