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Use of intravenous tissue plasminogen activator and hospital costs for patients with acute ischaemic stroke aged 18–64 years in the USA

INTRODUCTION: Intravenous tissue plasminogen activator (IV tPA) is a globally recommended treatment for patients with acute ischaemic stroke. We examined IV tPA use among patients aged 18–64 years with a primary diagnosis of acute ischaemic stroke in the USA and inpatient costs per hospitalisation b...

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Autores principales: Joo, Heesoo, Wang, Guijing, George, Mary G
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990217/
https://www.ncbi.nlm.nih.gov/pubmed/27547449
http://dx.doi.org/10.1136/svn-2015-000002
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author Joo, Heesoo
Wang, Guijing
George, Mary G
author_facet Joo, Heesoo
Wang, Guijing
George, Mary G
author_sort Joo, Heesoo
collection PubMed
description INTRODUCTION: Intravenous tissue plasminogen activator (IV tPA) is a globally recommended treatment for patients with acute ischaemic stroke. We examined IV tPA use among patients aged 18–64 years with a primary diagnosis of acute ischaemic stroke in the USA and inpatient costs per hospitalisation by IV tPA use status among these patients. METHODS: Using the 2010–2013 MarketScan Commercial Claims and Encounters Inpatient Data, we identified 39 149 hospitalisations with a primary diagnosis of acute ischaemic stroke. We verified those with and without IV tPA by ICD-9 procedure code 99.10. We estimated trends in IV tPA use by applying logistic regression. The average inpatient costs per acute ischaemic stroke hospitalisation were assessed for subpopulations. We examined costs per acute ischaemic stroke hospitalisation using multivariate regression models controlling for IV tPA status, age, gender, urbanisation, geographic region, Charlson comorbidity index, length of hospital stays (LOS) and discharge status. RESULTS: 2546 hospitalisations (6.5%) used IV tPA. IV tPA use increased over time (2010 vs 2013; OR 1.50). Average inpatient costs per acute ischaemic stroke hospitalisation were $20 331 ($31 369 for the IV tPA group, $19 563 for the non-tPA group). From multivariate analyses, higher costs per acute ischaemic stroke hospitalisation were associated with longer LOS, non-home discharge destination, and IV tPA use, which might be correlated with severity of stroke. CONCLUSIONS: Findings suggest that IV tPA use has increased in recent years while the inpatient costs per acute ischaemic stroke hospitalisation using IV tPA are substantial. Those findings are useful in better understanding the overall economic burden of stroke, short-term cost implications of using IV tPA, and for estimating the accurate cost-effectiveness of stroke treatments.
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spelling pubmed-49902172017-03-01 Use of intravenous tissue plasminogen activator and hospital costs for patients with acute ischaemic stroke aged 18–64 years in the USA Joo, Heesoo Wang, Guijing George, Mary G Stroke Vasc Neurol Original Article INTRODUCTION: Intravenous tissue plasminogen activator (IV tPA) is a globally recommended treatment for patients with acute ischaemic stroke. We examined IV tPA use among patients aged 18–64 years with a primary diagnosis of acute ischaemic stroke in the USA and inpatient costs per hospitalisation by IV tPA use status among these patients. METHODS: Using the 2010–2013 MarketScan Commercial Claims and Encounters Inpatient Data, we identified 39 149 hospitalisations with a primary diagnosis of acute ischaemic stroke. We verified those with and without IV tPA by ICD-9 procedure code 99.10. We estimated trends in IV tPA use by applying logistic regression. The average inpatient costs per acute ischaemic stroke hospitalisation were assessed for subpopulations. We examined costs per acute ischaemic stroke hospitalisation using multivariate regression models controlling for IV tPA status, age, gender, urbanisation, geographic region, Charlson comorbidity index, length of hospital stays (LOS) and discharge status. RESULTS: 2546 hospitalisations (6.5%) used IV tPA. IV tPA use increased over time (2010 vs 2013; OR 1.50). Average inpatient costs per acute ischaemic stroke hospitalisation were $20 331 ($31 369 for the IV tPA group, $19 563 for the non-tPA group). From multivariate analyses, higher costs per acute ischaemic stroke hospitalisation were associated with longer LOS, non-home discharge destination, and IV tPA use, which might be correlated with severity of stroke. CONCLUSIONS: Findings suggest that IV tPA use has increased in recent years while the inpatient costs per acute ischaemic stroke hospitalisation using IV tPA are substantial. Those findings are useful in better understanding the overall economic burden of stroke, short-term cost implications of using IV tPA, and for estimating the accurate cost-effectiveness of stroke treatments. BMJ Publishing Group 2016-02-16 /pmc/articles/PMC4990217/ /pubmed/27547449 http://dx.doi.org/10.1136/svn-2015-000002 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Original Article
Joo, Heesoo
Wang, Guijing
George, Mary G
Use of intravenous tissue plasminogen activator and hospital costs for patients with acute ischaemic stroke aged 18–64 years in the USA
title Use of intravenous tissue plasminogen activator and hospital costs for patients with acute ischaemic stroke aged 18–64 years in the USA
title_full Use of intravenous tissue plasminogen activator and hospital costs for patients with acute ischaemic stroke aged 18–64 years in the USA
title_fullStr Use of intravenous tissue plasminogen activator and hospital costs for patients with acute ischaemic stroke aged 18–64 years in the USA
title_full_unstemmed Use of intravenous tissue plasminogen activator and hospital costs for patients with acute ischaemic stroke aged 18–64 years in the USA
title_short Use of intravenous tissue plasminogen activator and hospital costs for patients with acute ischaemic stroke aged 18–64 years in the USA
title_sort use of intravenous tissue plasminogen activator and hospital costs for patients with acute ischaemic stroke aged 18–64 years in the usa
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990217/
https://www.ncbi.nlm.nih.gov/pubmed/27547449
http://dx.doi.org/10.1136/svn-2015-000002
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