Rai Ansaar T, Evans Kim
Department of Radiology and Neurosurgery and Neurology, West Virginia University Healthcare, Morgantown, West Virginia, USA.
Decision Support West Virginia University Healthcare, Morgantown, West Virginia, USA.
J Neurointerv Surg. 2015 Feb;7(2):150-6. doi: 10.1136/neurintsurg-2013-011085. Epub 2014 Jan 29.
Economic viability is important to any hospital striving to be a comprehensive stroke center. An inability to recover cost can strain sustained delivery of advanced stroke care.
To carry out a comparative financial analysis of intravenous (IV) recombinant tissue plasminogen activator and endovascular (EV) therapy in treating large vessel strokes from a hospital's perspective.
Actual hospital's charges, costs, and payments were analyzed for 265 patients who received treatment for large vessel strokes. The patients were divided into an EV (n=141) and an IV group (n=124). The net gain/loss was calculated as the difference between payments received and the total cost.
The charges, costs, and payments were significantly higher for the EV than the IV group (p<0.0001 for all). Medicare A was the main payer. Length of stay was inversely related to net gain/loss (p<0.0001). Favorable outcome was associated with a net gain of $3853 (±$21,155) and poor outcome with a net deficit of $2906 (±$15,088) (p=0.003). The hospital showed a net gain for the EV group versus a net deficit for the IV group in patients who survived the admission (p=0.04), had a favorable outcome (p=0.1), or were discharged to home (p=0.03). There was no difference in the time in hospital based on in-hospital mortality for the EV group but patients who died in the IV group had a significantly shorter length of stay than those who survived (p=0.04). The favorable outcome of 42.3% in the EV group was significantly higher than the 29.4% in the IV group (p=0.03).
Endovascular therapy was associated with better outcomes and higher cost-recovery than IV thrombolysis in patients with large vessel strokes.
对于任何一家努力成为综合性卒中中心的医院而言，经济可行性都很重要。无法收回成本可能会给持续提供高级卒中护理带来压力。
从医院的角度对静脉注射重组组织型纤溶酶原激活剂和血管内治疗在治疗大血管卒中方面进行财务比较分析。
分析了265例接受大血管卒中治疗患者的实际医院收费、成本和支付情况。这些患者被分为血管内治疗组（n = 141）和静脉注射组（n = 124）。净收益/损失计算为收到的支付与总成本之间的差值。
血管内治疗组的收费、成本和支付显著高于静脉注射组（所有p值均<0.0001）。医疗保险A是主要支付方。住院时间与净收益/损失呈负相关（p<0.0001）。良好结局与净收益3853美元（±21155美元）相关，不良结局与净亏损2906美元（±15088美元）相关（p = 0.003）。在入院存活的患者中（p = 0.04）、有良好结局的患者中（p = 0.1）或出院回家的患者中（p = 0.03），医院血管内治疗组显示出净收益，而静脉注射组显示出净亏损。血管内治疗组基于院内死亡率的住院时间没有差异，但静脉注射组中死亡的患者住院时间明显短于存活患者（p = 0.04）。血管内治疗组42.3%的良好结局显著高于静脉注射组的29.4%（p = 0.03）。
在大血管卒中患者中，血管内治疗与比静脉溶栓更好的结局和更高的成本回收相关。
