COST-EFFECTIVENESS OF EMERGENCY INTRAARTERIAL INTRACEREBRAL THROMBOLYSIS - A PILOT-STUDY

PURPOSE: To assess the clinical efficacy and cost-effectiveness of eme rgency thrombolysis as a treatment strategy for thromboembolic intrace rebral events. METHODS: Thirty-four patients with symptoms suggestive of middle cerebral artery occlusion were included. Eight of these pati ents were treated with intraarterial urokinase. Effectiveness was dete rmined 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 m easures of direct cost. The likelihood of admission to extended care f acilities and estimated length cost of admission was used as a measure of indirect cost. RESULTS: The control population became slightly wor se, with a change in National Institutes of Health score of -0.5, wher eas the treated population improved slightly, with a change in Nationa l Institutes of Health score of +5.12. Analysis of the direct costs da ta between the two populations revealed a slight increased mean for th e treated population ($15 202) as compared with the control population ($13 478). The unpaired t test, however, revealed no significant cost difference between the two groups. By reducing the number of complete d strokes by one third or by decreasing the severity by the same Facto r (as shown in our study), the likelihood of admission to an extended nursing facility also is decreased. The cost saving per patient from e xtended care facilities is approximately $3435. CONCLUSION: The emerge ncy application of intraarterial thrombolysis with urokinase results i n a statistically significant positive change in National Institutes o f Health score by at least five points. A statistically significant be nefit is realized through the use of intraarterial urokinase. A statis tically insignificant additional cost is shown by this study. This ins ignificant cost is more than offset by the saved nursing home costs.