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Original research
Outcomes associated with endovascular treatment among patients with acute ischemic stroke in the USA
  1. Ansaar T Rai1,
  2. Concetta Crivera2,
  3. Emilie Kottenmeier3,
  4. Iftekhar Kalsekar4,
  5. Rashmi Kumari5,
  6. Nataly Patino4,
  7. Farid Chekani4,
  8. Rahul Khanna4
  1. 1 Interventional Neuroradiology, West Virginia University Hospital, Morgantown, West Virginia, USA
  2. 2 Janssen Pharmaceutical Companies of Johnson and Johnson, Titusville, New Jersey, USA
  3. 3 Franchise Health Economics and Outcomes Research, Biosense Webster Inc, Irvine, California, USA
  4. 4 Medical Device Epidemiology, Johnson and Johnson Medical Devices, New Brunswick, New Jersey, USA
  5. 5 Mu Sigma Business Solutions Private Ltd, Bangalore, Karnataka, India
  1. Correspondence to Dr Rahul Khanna, Medical Device Epidemiology, Johnson and Johnson Medical Devices, Irvine, CA 92618, USA; rkhann14{at}its.jnj.com

Abstract

Background Few studies have examined the trends in clinical and economic outcomes of patients with acute ischemic stroke (AIS) who receive endovascular therapy (ET) in the real-world setting.

Objective To evaluate characteristics and trends in clinical and economic outcomes among commercially insured patients with AIS undergoing ET between 2011 and 2017.

Methods Patients with AIS undergoing ET from January 1, 2011 to June 30, 2017 were identified from administrative claims contained in the IBM MarketScan Commercial and Medicare Supplemental databases. The Mann–Kendall trend test was performed to examine clinical and economic trends.

Between 2011 and 2017, 3411 patients (mean age 62.85±15 years) with a primary diagnosis of AIS underwent ET (coverage: Commercial 59%, n=2008; Medicare Supplemental 41%, n=1403). In the Commercial cohort, discharge to home increased significantly (from 29.54% to 39.18%, p<0.05). Length of stay declined significantly among the overall cohort (from 10.96 to 9.05 days, p<0.01) and the Medicare Supplemental cohort (from 10.03 to 8.43 days, p<0.05). All-cause 365-day readmission decreased significantly among the overall cohort (from 47.5% to 36.7%, p<0.05) and the Commercial cohort (from 51.54% to 36.43%, p<0.05) but remained unchanged in the Medicare Supplemental cohort. While index procedure cost did not change significantly ($93 955 to $87 906, p=0.8806), total cost significantly declined in the overall cohort (from $166 922 to $130 678, p<0.05).

Conclusions Although with some variation across the samples studied, outcomes including discharge to home, length of stay, readmission, and total cost associated with endovascular stroke therapy seemed to have improved between 2011 and 2017. Index admission cost remained unchanged.

  • thrombectomy
  • stroke
  • economics
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Footnotes

  • Twitter @Ansaar_Rai

  • Contributors AR, CC, IK, RK, NP, FC, and RK were involved in study design, results interpretation, and manuscript development. RK, NP, FC, and RK were involved in data analysis. EK was involved in results interpretation and manuscript development.

  • Funding This work was funded by Johnson and Johnson.

  • Competing interests CC, EK, IK, and RKh are Johnson and Johnson employees. RKu is an employee of MuSigma Inc, which has a consulting agreement with Johnson and Johnson. NP and FC were Johnson and Johnson employees at the time of the conduct of the study. AR has a consulting agreement with Stryker Neurovascular.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.

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