Study offers lessons on cost drivers for acute stroke care

February 17, 2014 by Keith Herrell, University of Cincinnati

A six-year, federally funded study comparing treatments for stroke-causing blood clots offers important lessons on cost drivers during initial hospitalization for acute ischemic stroke patients, researchers at the University of Cincinnati (UC) say.

The study, the Interventional Management of Stroke III trial, compared the use of devices or medication within the arteries to treat the clots at the site of blockage in the brain with the current standard treatment of intravenous (IV) clot-busting medication alone. UC was the clinical coordinating center for the trial.

Joseph Broderick, MD, Distinguished Research Professor in the department of neurology and rehabilitation medicine and director of the UC Neuroscience Institute, presented findings today (Friday, Feb. 14) at the American Heart Association/American Stroke Association's annual International Stroke Conference 2014 in San Diego.

"The annual costs of stroke in the United States have been estimated to be over $38 billion by the Centers for Disease Control and Prevention, with nearly $22 billion attributed to direct medical costs," Broderick says. "With information from the IMS III study, we sought to understand some of the cost drivers behind those figures."

While a number of factors contributed to costs, Broderick emphasizes that earlier treatment, typically with intravenous delivery of the clot-busting drug (tPA), translates to lower costs.

"Time is brain," he says, referring to the well-known saying within the medical profession, "but time is also money."

The IMS III trial was begun in 2006 and funded by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health (NIH). Participants were randomized to receive either the standard Food and Drug Administration (FDA)-approved treatment of IV tPA alone or a combination approach that provided both IV tPA and an endovascular therapy using either tPA delivered into the artery directly at the site of the clot or an FDA-approved device to remove the clot. (Enrollment was stopped in 2012 when it became clear that the combination approach was unlikely to demonstrate the desired minimum benefit.)

The cost of a hospital admission for in the study was $35,130 for subjects treated with the combination approach and $25,630 for subjects treated with IV tPA alone. The higher cost for the combination therapy was largely explained by the costs of the devices, Broderick says.

Other significant factors for costs in addition to devices and time to treatment included:

  • Stroke severity (higher costs with higher severity).
  • Stroke location (higher costs with right hemispheric location).
  • Co-morbid diabetes (higher costs with diabetes).
  • Use of general anesthesia (rather than conscious sedation) as part of endovascular therapy.

"Changing the processes of care, such as minimizing the time to start IV tPA and decreasing the use of routine general anesthesia, may improve the cost-effectiveness of medical and endovascular therapy for acute ischemic ," Broderick says.

Explore further: Adding endovascular therapy to tPA didn't improve recovery after stroke

Related Stories

Adding endovascular therapy to tPA didn't improve recovery after stroke

February 8, 2013
Adding endovascular therapy to clot-busting therapy for stroke did not significantly improve stroke recovery at three months, according to a study presented in a special symposium at the American Stroke Association's International ...

Most people have access to stroke care, but few get recommended treatment

February 13, 2014
Four out of five people in the United States live within an hour's drive of a hospital equipped to treat acute stroke—yet very few get recommended treatment, according to research presented at the American Stroke Association's ...

Clot busters limit stroke damage despite age; stroke severity

February 13, 2014
Regardless of a patient's age, or severity of stroke, prompt treatment with a clot-busting drug limited stroke-related disability, according to late-breaking science presented at the American Stroke Association's International ...

Study shows combination stroke therapy safe and effective

July 30, 2013
The combination of the clot-busting drug tPA with an infusion of the antiplatelet drug eptifibatide dissolves blood clots safely and more quickly than tPA alone, a study led by University of Cincinnati (UC) researchers has ...

Delay in breaking up blood clots means worse stroke outcome

February 11, 2013
Every 30-minute delay in breaking up a blood clot from a stroke was associated with a 10 percent decrease in the probability of a good outcome, regardless of other factors such as stroke severity, according to late-breaking ...

Hands-free ultrasound device with clot-busting drug safe for stroke patients

October 24, 2013
A hands-free ultrasound device combined with a clot-busting drug was safe for ischemic stroke patients in a phase II pilot study, reported in the American Heart Association journal Stroke.

Recommended for you

A nanoparticle inhalant for treating heart disease

January 18, 2018
A team of researchers from Italy and Germany has developed a nanoparticle inhalant for treating people suffering from heart disease. In their paper published in the journal Science Translational Medicine, the group describes ...

Starting periods before age of 12 linked to heightened risk of heart disease and stroke

January 15, 2018
Starting periods early—before the age of 12—is linked to a heightened risk of heart disease and stroke in later life, suggests an analysis of data from the UK Biobank study, published online in the journal Heart.

'Decorated' stem cells could offer targeted heart repair

January 10, 2018
Although cardiac stem cell therapy is a promising treatment for heart attack patients, directing the cells to the site of an injury - and getting them to stay there - remains challenging. In a new pilot study using an animal ...

Two simple tests could help to pinpoint cause of stroke

January 10, 2018
Detecting the cause of the deadliest form of stroke could be improved by a simple blood test added alongside a routine brain scan, research suggests.

Exercise is good for the heart, high blood pressure is bad—researchers find out why

January 10, 2018
When the heart is put under stress during exercise, it is considered healthy. Yet stress due to high blood pressure is bad for the heart. Why? And is this always the case? Researchers of the German Centre for Cardiovascular ...

Heart-muscle patches made with human cells improve heart attack recovery

January 10, 2018
Large, human cardiac-muscle patches created in the lab have been tested, for the first time, on large animals in a heart attack model. This clinically relevant approach showed that the patches significantly improved recovery ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.