Background Large vessel occlusions constitute a substantial subgroup of ischaemic stroke patients that carry a high morbidity and mortality and poor outcomes. In order to classify these as a separate disease entity it is also important to demonstrate the higher financial burden associated with the current standard of care of intravenous thrombolysis for this subgroup. Future clinical trials comparing different treatments should thus be targeted at this high-risk group.

Methodology The hospital charges, direct cost, total cost, length of stay, discharge destination, payments received and the DRG utilised were obtained for 237 acute ischaemic stroke patients who underwent intravenous thrombolysis over an 8-year period. Patients were divided into two groups based on the presence or absence of a large vessel occlusion (LVO) based on the admission CTA. A LVO was defined as involvement of the ICA-terminus, the MCA (M1 or M2 origin) or the BA. The functional outcome was defined as an mRS of 0–2 at 90 days. All financial parameters were compared for the two groups and the net gain/loss was calculated as the difference between the payments received and the total hospital cost.

Results As shown in table 1, the LVO-group (n=122) had significantly higher charges, direct cost and total cost as well as longer length of stay compared to the No-LVO group (n=115). Overall, there was no significant difference in payments received by the hospital. The hospital on average had a net loss of $1800 per LVO admission treated with IV thrombolysis as opposed to a net gain of $476 for patients in the No-LVO group (p=0.14). This difference however became larger and significant once patients who had died during their admission were excluded from the analysis. Amongst patients who survived and were discharged, the hospital had a net loss of $2952 per LVO patient versus a net gain of $572 for the No-LVO patient (p=0.03). In the LVO-group, 56% of the patients were discharged to a rehab facility as opposed to only 27% for the No-LVO-group (p<0.0001). Lastly, only 26% of the LVO patients achieved a favourable outcome versus a favourable outcome of 76% for the No-LVO-group.

Conclusion Large vessel strokes undergoing intravenous thrombolysis with rt-PA not only result in worse functional outcomes but also incur a significant financial loss, of almost $3000, for the hospital compared to patients without a large vessel occlusion.

Disclosures A. Rai: 2; C; Stryker Neurovascular.