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Hospital-based financial analysis of endovascular therapy and intravenous thrombolysis for large vessel acute ischemic strokes: the ‘bottom line’
  1. Ansaar T Rai1,
  2. Kim Evans2
  1. 1Department of Radiology and Neurosurgery and Neurology, West Virginia University Healthcare, Morgantown, West Virginia, USA
  2. 2Decision Support West Virginia University Healthcare, Morgantown, West Virginia, USA
  1. Correspondence to Dr Ansaar T Rai, Department of Radiology and Neurosurgery and Neurology, West Virginia University Healthcare, Room 2278, HSCS, PO Box 9235, Morgantown, WV 26506, USA; ansaar.rai{at}gmail.com

Abstract

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.

Methodology 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.

  • Economics
  • Stroke
  • Thrombolysis
  • Thrombectomy

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