title: Drivers of costs associated with reperfusion therapy in acute stroke: the Interventional Management of Stroke III Trial.
abstract: OBJECTIVE
  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.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00359424.
authors.affiliation: 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.
authors.forename: Kit N
authors.initials: KN
authors.lastname: Simpson
authors.affiliation: 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.
authors.forename: Annie N
authors.initials: AN
authors.lastname: Simpson
authors.affiliation: 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.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Mauldin
authors.affiliation: 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.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
authors.affiliation: 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.
authors.forename: Sharon D
authors.initials: SD
authors.lastname: Yeatts
authors.affiliation: 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.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Spilker
authors.affiliation: 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.
authors.forename: Lydia D
authors.initials: LD
authors.lastname: Foster
authors.affiliation: 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.
authors.forename: Pooja
authors.initials: P
authors.lastname: Khatri
authors.affiliation: 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.
authors.forename: Renee
authors.initials: R
authors.lastname: Martin
authors.affiliation: 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.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Jauch
authors.affiliation: 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.
authors.forename: Dawn
authors.initials: D
authors.lastname: Kleindorfer
authors.affiliation: 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.
authors.forename: Yuko Y
authors.initials: YY
authors.lastname: Palesch
authors.affiliation: 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.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Broderick
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000191:economics*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000191:economics* / Q000628:therapy; D015912:Thrombolytic Therapy / Q000191:economics*; D010959:Tissue Plasminogen Activator / Q000191:economics* / Q000627:therapeutic use; D014481:United States
chemical_list: D010959:Tissue Plasminogen Activator
keywords: brain ischemic; costs and cost analysis; hospitals; reperfusion; stroke