title: Optimizing the Economic Impact of rtPA Use in a Stroke Belt State: The Case of South Carolina.
abstract: BACKGROUND
  Stroke is the fourth leading cause of death in the United States, and its incidence is especially high in South Carolina. Recombinant tissue plasminogen activator (rtPA) has been given to patients with acute ischemic stroke since 1996 and has shown overall improved outcomes relative to patients who are not treated with rtPA.
  
  
  OBJECTIVE
  A 1998 study by Fagan and colleagues reported the economic impact of the use of rtPA. The purpose of this current article is to present an updated economic analysis of the impact of rtPA.
  
  
  METHODS
  In the current analysis, an updated estimate of the economic and health benefits of treatment with rtPA in South Carolina was provided using estimates of cost, incidence, and course of treatment from several data sources. The Markov model in the 1998 study was used as a guide in this current study; we sought to replicate the methodology, while providing updated economic figures and applying it to the state of South Carolina. We estimated the costs per 1000 patients who are eligible for treatment with rtPA compared with 1000 untreated patients, as well as routine medical practice and outcomes of quality-adjusted life-years (QALYs) and economic costs based on whether a patient was treated with rtPA or not. We calculated the number of stroke cases that would be treated with rtPA if the rate were to increase from 3% to 20%, using the most recent number of strokes in South Carolina and prorating for 5 years to estimate the total expected cost-savings with increased rtPA use.
  
  
  RESULTS
  The results indicate that the use of rtPA in South Carolina accounts for a cost-savings of $3454 per treated patient over a 6-year period. The model estimates an increase of 0.425 QALYs (or 5.1 quality-adjusted months) of survival per patient treated with rtPA. Over the lifetime of a treated patient, the estimated cost-savings are $4084, with an accrued health benefit of 0.692 QALYs (or 8.3 quality-adjusted months). For every 100 patients treated with rtPA, there is a gain of 69.17 QALYs and of $408,419 over the lifetime of 100 treated patients with acute ischemic stroke. We calculated that the cost-savings gained by increasing the rtPA treatment rate in a state with a high incidence of stroke from the current 3% rate to an achievable 20% rate over a 5-year period would be $16,615,723.
  
  
  CONCLUSIONS
  This new analysis demonstrates a significant savings associated with the use of rtPA for patients with stroke and provides great support for the increased systematic use of rtPA in the state of South Carolina for patients with acute ischemic stroke. For every additional 100 patients who are treated with rtPA in South Carolina, a robust savings supports the wider economic benefit that would be gained with an increased use of rtPA.
authors.affiliation: Program Director, Master of Health Administration Program, and Associate Professor, Department of Health Care Management and Leadership.
authors.forename: Abby Swanson
authors.initials: AS
authors.lastname: Kazley
authors.affiliation: Professor, Department of Health Care Management and Leadership, Medical University of South Carolina.
authors.forename: Kit N
authors.initials: KN
authors.lastname: Simpson
authors.affiliation: Assistant Professor, Department of Health Care Management and Leadership, Medical University of South Carolina.
authors.forename: Annie
authors.initials: A
authors.lastname: Simpson
authors.affiliation: Professor, Department of Neurosciences, Medical University of South Carolina.
authors.forename: Edward
authors.initials: E
authors.lastname: Jauch
authors.affiliation: Distinguished Professor and Co-Director, Comprehensive Stroke and Cerebrovascular Center, Medical University of South Carolina.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Adams