Cost-effectiveness of emergency intraarterial intracerebral thrombolysis: A pilot study

C. F. Lanzieri, R. W. Tarr, D. Landis, W. R. Selman, J. S. Lewin, L. P. Adler

Research output: Contribution to journalArticle

Abstract

PURPOSE: To assess the clinical efficacy and cost-effectiveness of emergency thrombolysis as a treatment strategy for thromboembolic intracerebral events. METHODS: Thirty-four patients with symptoms suggestive of middle cerebral artery occlusion were included. Eight of these patients were treated with intraarterial urokinase. Effectiveness was determined by comparing the admission National Institutes of Health stroke score to the 24- hour National Institutes of Health stroke score. The cost and length of stay of both populations were derived and used as measures of direct cost. The likelihood of admission to extended care facilities and estimated length cost of admission was used as a measure of indirect cost. RESULTS: The control population became slightly worse, with a change in National Institutes of Health score of 0.5, whereas the treated population improved slightly, with a change in National Institutes of Health score of +5.12. Analysis of the direct costs data between the two populations revealed a slight increased mean for the treated population ($15 202) as compared with the control population ($13478). The unpaired t test, however, revealed no significant cost difference between the two groups. By reducing the number of completed strokes by one third or by decreasing the severity by the same factor (as shown in our study), the likelihood of admission to an extended nursing facility also is decreased. The cost saving per patient from extended care facilities is approximately $3435. CONCLUSION: The emergency application of intraarterial thrombolysis with urokinase results in a statistically significant positive change in National Institutes of Health score by at least five points. A statistically significant benefit is realized through the use of intraarterial urokinase. A statistically insignificant additional cost is shown by this study. This insignificant cost is more than offset by the saved nursing home costs.

Original languageEnglish (US)
Pages (from-to)1987-1993
Number of pages7
JournalAmerican Journal of Neuroradiology
Volume16
Issue number10
StatePublished - 1995
Externally publishedYes

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Cost-Benefit Analysis
Emergencies
Costs and Cost Analysis
National Institutes of Health (U.S.)
Urokinase-Type Plasminogen Activator
Skilled Nursing Facilities
Population
Stroke
Middle Cerebral Artery Infarction
Nursing Homes
Length of Stay
Patient Care
Nursing

Keywords

  • Brain, infarction
  • Economics
  • Thrombolysis

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Lanzieri, C. F., Tarr, R. W., Landis, D., Selman, W. R., Lewin, J. S., & Adler, L. P. (1995). Cost-effectiveness of emergency intraarterial intracerebral thrombolysis: A pilot study. American Journal of Neuroradiology, 16(10), 1987-1993.

Cost-effectiveness of emergency intraarterial intracerebral thrombolysis : A pilot study. / Lanzieri, C. F.; Tarr, R. W.; Landis, D.; Selman, W. R.; Lewin, J. S.; Adler, L. P.

In: American Journal of Neuroradiology, Vol. 16, No. 10, 1995, p. 1987-1993.

Research output: Contribution to journalArticle

Lanzieri, CF, Tarr, RW, Landis, D, Selman, WR, Lewin, JS & Adler, LP 1995, 'Cost-effectiveness of emergency intraarterial intracerebral thrombolysis: A pilot study', American Journal of Neuroradiology, vol. 16, no. 10, pp. 1987-1993.
Lanzieri CF, Tarr RW, Landis D, Selman WR, Lewin JS, Adler LP. Cost-effectiveness of emergency intraarterial intracerebral thrombolysis: A pilot study. American Journal of Neuroradiology. 1995;16(10):1987-1993.
Lanzieri, C. F. ; Tarr, R. W. ; Landis, D. ; Selman, W. R. ; Lewin, J. S. ; Adler, L. P. / Cost-effectiveness of emergency intraarterial intracerebral thrombolysis : A pilot study. In: American Journal of Neuroradiology. 1995 ; Vol. 16, No. 10. pp. 1987-1993.
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N2 - PURPOSE: To assess the clinical efficacy and cost-effectiveness of emergency thrombolysis as a treatment strategy for thromboembolic intracerebral events. METHODS: Thirty-four patients with symptoms suggestive of middle cerebral artery occlusion were included. Eight of these patients were treated with intraarterial urokinase. Effectiveness was determined by comparing the admission National Institutes of Health stroke score to the 24- hour National Institutes of Health stroke score. The cost and length of stay of both populations were derived and used as measures of direct cost. The likelihood of admission to extended care facilities and estimated length cost of admission was used as a measure of indirect cost. RESULTS: The control population became slightly worse, with a change in National Institutes of Health score of 0.5, whereas the treated population improved slightly, with a change in National Institutes of Health score of +5.12. Analysis of the direct costs data between the two populations revealed a slight increased mean for the treated population ($15 202) as compared with the control population ($13478). The unpaired t test, however, revealed no significant cost difference between the two groups. By reducing the number of completed strokes by one third or by decreasing the severity by the same factor (as shown in our study), the likelihood of admission to an extended nursing facility also is decreased. The cost saving per patient from extended care facilities is approximately $3435. CONCLUSION: The emergency application of intraarterial thrombolysis with urokinase results in a statistically significant positive change in National Institutes of Health score by at least five points. A statistically significant benefit is realized through the use of intraarterial urokinase. A statistically insignificant additional cost is shown by this study. This insignificant cost is more than offset by the saved nursing home costs.

AB - PURPOSE: To assess the clinical efficacy and cost-effectiveness of emergency thrombolysis as a treatment strategy for thromboembolic intracerebral events. METHODS: Thirty-four patients with symptoms suggestive of middle cerebral artery occlusion were included. Eight of these patients were treated with intraarterial urokinase. Effectiveness was determined by comparing the admission National Institutes of Health stroke score to the 24- hour National Institutes of Health stroke score. The cost and length of stay of both populations were derived and used as measures of direct cost. The likelihood of admission to extended care facilities and estimated length cost of admission was used as a measure of indirect cost. RESULTS: The control population became slightly worse, with a change in National Institutes of Health score of 0.5, whereas the treated population improved slightly, with a change in National Institutes of Health score of +5.12. Analysis of the direct costs data between the two populations revealed a slight increased mean for the treated population ($15 202) as compared with the control population ($13478). The unpaired t test, however, revealed no significant cost difference between the two groups. By reducing the number of completed strokes by one third or by decreasing the severity by the same factor (as shown in our study), the likelihood of admission to an extended nursing facility also is decreased. The cost saving per patient from extended care facilities is approximately $3435. CONCLUSION: The emergency application of intraarterial thrombolysis with urokinase results in a statistically significant positive change in National Institutes of Health score by at least five points. A statistically significant benefit is realized through the use of intraarterial urokinase. A statistically insignificant additional cost is shown by this study. This insignificant cost is more than offset by the saved nursing home costs.

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