Introduction: Intravenous alteplase (tissue plasminogen activator) has been shown to be cost-effective due to savings in long-term disability. In October of 2005, an increased DRG payment to hospitals for alteplase-treated stroke patients was introduced. We sought to describe the trends in the cost of alteplase over time, in comparison to trends in hospital reimbursement in the United States.
Methods: Utilizing publicly available information on the Centers for Medicare and Medicaid Services (CMS) website (http://www.cms.gov), we obtained CMS quarterly payment amounts between 1/1/2005-10/1/2014 for alteplase, listed as “alteplase recombinant, per mg.” CMS payment amounts are the manufacturer’s average sales price (ASP) + 6% until 4/2014, when it was lowered to + 4.3%. Estimates for DRG base payments were calculated within MEDPAR for FY 2006 (DRG 559) and 2013 (MS DRGs 61,62, and 63) as: (DRG relative weights) x (standardized operating and capital amount). The Consumer Price Index (CPI) was also queried for all prescription drugs, urban areas, during the same study period as reference.
Results: The CMS payment amount for alteplase/mg was $30.50 in 1/2005, and $64.30 in 10/2014. Trends in the CMS payment amounts for alteplase increased by 111% between 2005-2014, shown in the Figure. The CPI for all prescription drugs increased by 30.2% in the same time frame. The base payment for alteplase-treated stroke admissions was $11,173 in 2006, and $12,064 in 2013, an 8% increase.
Discussion: We found a striking increase in the cost of alteplase over the last decade, with a 100mg vial now with a CMS payment of ∼$6400, a more than 100% increase over ten years. During the same timeframe, the DRG base payment to hospitals increased by only 8%, and alteplase cost increased from 27% of the payment in 2006 to 53% in 2013. Researchers and stroke physicians should be aware of these changes in drug costs and their impact on cost-effectiveness analyses.