title: Intravenous thrombolysis of large vessel occlusions is associated with higher hospital costs than small vessel strokes: a rationale for developing stroke severity-based financial models.
abstract: BACKGROUND
  Owing to their severity, large vessel occlusion (LVO) strokes may be associated with higher costs that are not reflected in current coding systems. This study aimed to determine whether intravenous thrombolysis costs are related to the presence or absence of LVO.
  
  
  METHODS
  Patients who had undergone intravenous thrombolysis over a 9-year period were divided into LVO and no LVO (nLVO) groups based on admission CT angiography. The primary outcome was hospital cost per admission. Secondary outcomes included admission duration, 90-day clinical outcome, and discharge destination.
  
  
  RESULTS
  119 patients (53%) had LVO and 104 (47%) had nLVO. Total mean±SD cost per LVO patient was $18,815±14,262 compared with $15,174±11,769 per nLVO patient (p=0.04). Hospital payments per admission were $17,338±13,947 and $15,594±16,437 for LVO and nLVO patients, respectively (p=0.4). A good outcome was seen in 33 LVO patients (27.7%) and in 69 nLVO patients (66.4%) (OR 0.2, 95% CI 0.1 to 0.3, p<0.0001). Hospital mortality occurred in 31 LVO patients (26.1%) and in 7 nLVO patients (6.7%) (OR 0.2, 95% CI 0.08 to 0.5, p<0.0001). 31 LVO patients (32.6%) were discharged to home versus 64 nLVO patients (61.5%) (OR 4.5, 95% CI 2.6 to 8, p<0.0001). Admission duration was 7.5±6.9 days in LVO patients versus 4.9±4.2 days in nLVO patients (p=0.0009). Multivariate regression analysis after controlling for comorbidities showed the presence of LVO to be an independent predictor of higher total hospital costs.
  
  
  CONCLUSIONS
  The presence or absence of LVO is associated with significant differences in hospital costs, outcomes, admission duration, and home discharge. These differences can be important when developing systems of care models for acute ischemic stroke.
authors: Department of Neuroradiology, Neurosurgery and Neurology West Virginia University Healthcare Room 2278, Morgantown, West Virginia, USA.
authors: Ansaar T
authors: AT
authors: Rai
authors: Decision Support, West Virginia University Healthcare, Morgantown, West Virginia, USA.
authors: Kim
authors: K
authors: Evans
authors: Department of Neurology, Morgantown, West Virginia, USA.
authors: Jack E
authors: JE
authors: Riggs
authors: Department of Statistics, HSCS, Morgantown, West Virginia, USA.
authors: Gerald R
authors: GR
authors: Hobbs
mesh_terms: D000046:Academic Medical Centers / Q000191:economics; D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D017721:Hospital Costs; D006780:Hospitals, Rural / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D015912:Thrombolytic Therapy / Q000191:economics*; D016896:Treatment Outcome
keywords: Economics; Stroke; Thrombolysis