Cost-effectiveness is integral in judging a treatment’s impact on healthcare. While endovascular therapy may yield better outcomes versus intravenous thrombolysis, the potential benefit is lost if the cost is prohibitive. A comparative analysis of IV rt-PA and endovascular therapy is warranted.Methodology
The setting is a rural tertiary-level academic hospital. The hospital charges, DRG, direct and indirect costs and payments received were analysed for 257 patients who received treatment for AIS. All patients had a large vessel occlusion (LVO) defined as involvement of the ICA-Terminus or the MCA on the admission CTA. The patients were divided into an endovascular (EV, n=141) and an intravenous thrombolysis group (IV, n=116). A favourable clinical outcome was defined as a 90-day mRS of 0–2. The net-cost was calculated as the difference between payments received and total hospital cost.Results
The DRGs used and the payments associated with each are listed in table 1. The total charges, direct and total hospital cost and the payments received were significantly higher for the EV than the IV-group (table 2). The direct cost was recovered in both groups however the net surplus was significantly higher for the EV-group. The difference between payments and total costs showed a net deficit for the IV-group and a net positive for the EV group. Amongst patients who lived, the hospitals had a net surplus of $3336 ( ± 22371) for EV-group as opposed a net deficit of $3118 ( ± 9349) for the IV-group (p=0.02). A favourable outcome was seen in 42% of the EV-group and 26.8% of the IV-group (p=0.007).Conclusion
Endovascular therapy was associated with a net-surplus for the hospital as opposed to intravenous thrombolysis, which was associated with a net-deficit. Additionally better functional outcomes for the EV-group make it the more cost-effective treatment option for large vessel strokes.Disclosures
A. Rai: 2; C; Stryker Neurovascular, Codman Neurovascular.