TPA In Stroke Pays For Itself In Health-Care Savings

February 08, 1997

ANAHEIM, Calif., Feb. 8 -- Clot-dissolver tissue plasminogen activator (TPA) can reduce the disability of people who survive an ischemic stroke, one caused by a clot that blocks an artery carrying blood to the brain. But given the drug's cost of over $2,000 a dose, are the benefits worth the money?

Yes, according to a new study that found using TPA not only provides a cost benefit, but saves a significant sum of money overall. "The use of TPA for eligible patients with acute ischemic stroke appears to be a 'win-win' situation, with improved patient outcomes accompanied by a net cost savings to the health care system," said Susan C. Fagan, Pharm.D., associate professor of pharmacy practice at Wayne State University College of Pharmacy in Detroit.

She reported the new findings here today at the American Heart Association's annual conference on stroke research.

In 1993, strokes cost $18 billion in direct health-care expenditures. According to the American Heart Association estimates the cost of stroke in 1997 to be $40.9 billion.

Ischemic strokes, which account for 70-80 percent of all strokes, will strike some 500,000 Americans in 1997. However, Fagan and her colleagues could not estimate how many of them might benefit from TPA because few stroke patients arrive in the emergency room within three hours after symptoms begin. TPA must be given within this time frame to be safe and effective.

Fagan and her co-workers used data gathered during the National Institute of Neurological Diseases and Stroke TPA Stroke Trial, a study of 624 acute ischemic stroke patients at nine medical centers. Half of the patients received TPA and the other half got a placebo (an inert substance).

Reported in 1995, the study found that at three months after a stroke, TPA significantly improved functional outcome but increased the risk of brain hemorrhage 10-fold (6.4 percent in the TPA group vs. 0.6 percent in the placebo group). There was no significant effect on mortality (17 percent in the drug group vs. 21 percent for placebo).

As a result of these findings, Fagan said, she and others who conducted the NINDS TPA study were frequently asked "whether it's worth it to use this expensive therapy in ischemic stroke patients."

So the investigators used data from the study, including as-yet-unpublished outcome results, and did a cost analysis using a set of reasonable assumptions. All patients, for example, were assumed to be 67 years old, the mean age of the patients in the NINDS TPA trial, and the cost of the TPA was set at $2,230, the mean price of the drug at seven Detroit-area hospitals. The yearly cost for nursing-home care was assumed to be $40,000.

The new study provides some outcome data not previously reported. The mean length of hospitalization immediately after the stroke was significantly longer for the placebo patients -- 12.4 days vs. 10.9 days for the TPA patients. "This finding was not explained by differences in the frequency of stroke subtypes between the two groups," Fagan said.

A significantly greater number of TPA patients went directly home after their initial hospitalization, rather than being discharged to a rehabilitation unit or a nursing home -- 151 (48 percent) vs. 112 (36 percent)e health care system for the 1,000 patients," Fagan and her colleagues noted. for the placebo group.

Both of these results proved major factors in the overall cost saving attributed to TPA by the study. "The treatment group did not require expensive post-hospital care as often as the placebo group," Fagan noted.

Using a computer model, she and her colleagues calculated that for every 1,000 ischemic stroke patients treated, using TPA would increase hospital costs by $2 million. However, the drug would decrease the cost of nursing home care by $4.8 million and rehabilitation costs by $2 million after the patient's initial hospitalization for stroke.

"The overall impact on both acute and long-term costs is a net decrease of almost $5 million to the health care system for the 1,000 patients," Fagan and her colleagues noted.

"In order to eliminate the overall cost savings, the length of hospital stay of the TPA group would have to exceed the placebo group by 2.6 days, or the nursing home cost per year would have to drop to near zero," Fagan said.

Given that no other effective therapy exists for ischemic stroke, the use of TPA is justified on its health benefits alone, the researchers concluded. The savings that result from using TPA offer an even greater incentive for its rapid administration to stroke patients.

"If this treatment is used properly, within three hours of onset of symptoms, it can actually save the health system money when you look at total health care costs," Fagan said.

Co-authors with Fagan were Lewis B. Morgenstern, M.D.; Antonio Petitta, R.Ph.; Richard E. Ward, M.D.; Barbara C. Tilley, Ph.D.; Steven R. Levine, M.D.; John R. Marler, M.D.; Michael D. Walker, M.D.; Joseph P. Broderick, M.D.; Thomas G. Kwiatkowski, M.D.; and Michael Frankel, M.D.
-end-


American Heart Association

Related Stroke Articles from Brightsurf:

Stroke alarm clock may streamline and accelerate time-sensitive acute stroke care
An interactive, digital alarm clock may speed emergency stroke care, starting at hospital arrival and through each step of the time-sensitive treatment process.

Stroke patients with COVID-19 have increased inflammation, stroke severity and death
Stroke patients who also have COVID-19 showed increased systemic inflammation, a more serious stroke severity and a much higher rate of death, compared to stroke patients who did not have COVID-19, according a retrospective, observational, cross-sectional study of 60 ischemic stroke patients admitted to UAB Hospital between late March and early May 2020.

'Time is vision' after a stroke
University of Rochester researchers studied stroke patients who experienced vision loss and found that the patients retained some visual abilities immediately after the stroke but these abilities diminished gradually and eventually disappeared permanently after approximately six months.

More stroke awareness, better eating habits may help reduce stroke risk for young adult African-Americans
Young African-Americans are experiencing higher rates of stroke because of health conditions such as high blood pressure, diabetes and obesity, yet their perception of their stroke risk is low.

How to help patients recover after a stroke
The existing approach to brain stimulation for rehabilitation after a stroke does not take into account the diversity of lesions and the individual characteristics of patients' brains.

Kids with headache after stroke might be at risk for another stroke
A new study has found a high incidence of headaches in pediatric stroke survivors and identified a possible association between post-stroke headache and stroke recurrence.

High stroke impact in low- and middle-income countries examined at 11th World Stroke Congress
Less wealthy countries struggle to meet greater need with far fewer resources.

Marijuana use might lead to higher risk of stroke, World Stroke Congress to be told
A five-year study of hospital statistics from the United States shows that the incidence of stroke has risen steadily among marijuana users even though the overall rate of stroke remained constant over the same period.

We need to talk about sexuality after stroke
Stroke survivors and their partners are not adequately supported to deal with changes to their relationships, self-identity, gender roles and intimacy following stroke, according to new research from the University of Sydney.

Standardized stroke protocol can ensure ELVO stroke patients are treated within 60 minutes
A new study shows that developing a standardized stroke protocol of having neurointerventional teams meet suspected emergent large vessel occlusion (ELVO) stroke patients upon their arrival at the hospital achieves a median door-to-recanalization time of less than 60 minutes.

Read More: Stroke News and Stroke Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.