Endovascular therapy is associated with significant cost. The current DRG system was revised in 2007 allowing for specific higher payment codes to potentially offset this higher cost. An higher use of mechanical devices may increase the cost. An analysis of the financial aspect of endovascular therapy is thus important in determining its place in stroke care.Methodology
Financial variables were available on 137. These included patient charges, the direct and indirect hospital costs and payments. Additionally, the clinical outcomes were also analysed. The net cost was determined by the difference between the payments and the total cost.Results
The charges, cost, payments and the difference between payments and the direct and total costs is given in table 1. There were 44 (32%) patients who received only intra-arterial rt-PA, 39 (28.5%) patients who received mechanical embolectomy only and 54 (39.4%) patients who received both. A Merci device was used in 30% of patients, Penumbra device in 29%, Solitaire in 6% and rt-PA in 64% of patients. The charges, costs and payments were significantly higher when mechanical embolectomy was used with or without intra-arterial rt-PA (table 2). The difference between reimbursements and costs favoured the use of a mechanical device however this was not significant. The use of multiple devices resulted in a net deficit (-$7916) as opposed to a single device use, which showed a positive balance ($3534) for the hospital (p=0.2). There were 54.6% of patients with a favourable outcome (mRS 0–2) when treated only with intra-arterial rt-PA as opposed to 37% of patients in whom a device was used.Conclusion
Endovascular therapy was favourable to the hospital without any net deficit. While this financial benefit was higher when a mechanical device was used, a higher number of patients achieved a favourable outcome when only local intra-arterial rt-PA was utilised.Disclosures
A. Rai: 2; C; Stryker Neurovascular, Codman Neurovascular.