From the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Academic Health Center, OH (J.P.B., D.K., P.K., J.A.S.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (M.D.H.); and Department of Healthcare Leadership and Management (K.N.S., A.N.S.), Department of General Internal Medicine (P.D.M.), Department of Public Health Sciences (S.D.Y., L.D.F., R.M., Y.Y.P.), Department of Emergency Medicine (E.C.J.), Medical University of South Carolina, Charleston.
Stroke. 2014 Jun;45(6):1791-8. doi: 10.1161/STROKEAHA.113.003874. Epub 2014 May 13.
The Interventional Management of Stroke (IMS) III study tested the effect of intravenous tissue-type plasminogen activator (tPA) alone when compared with intravenous tPA followed by endovascular therapy and collected cost data to assess the economic implications of the 2 therapies. This report describes the factors affecting the costs of the initial hospitalization for acute stroke subjects from the United States.
Prospective cost analysis of the US subjects was treated with intravenous tPA alone or with intravenous tPA followed by endovascular therapy in the IMS III trial. Results were compared with expected Medicare payments.
The adjusted cost of a stroke admission in the study was $35 130 for subjects treated with endovascular therapy after intravenous tPA treatment and $25 630 for subjects treated with intravenous tPA alone (P<0.0001). Significant factors related to costs included treatment group, baseline National Institutes of Health Stroke Scale, time from stroke onset to intravenous tPA, age, stroke location, and comorbid diabetes mellitus. The mean cost for subjects who had routine use of general anesthesia as part of endovascular therapy was $46 444 when compared with $30 350 for those who did not have general anesthesia. The costs of embolectomy for IMS III subjects and patients from the National Inpatient Sample cohort exceeded the Medicare diagnosis-related group payment in ≥75% of patients.
Minimizing the time to start of intravenous tPA and decreasing the use of routine general anesthesia may improve the cost-effectiveness of medical and endovascular therapy for acute stroke.
http://www.clinicaltrials.gov. Unique identifier: NCT00359424.
介入性卒中治疗（IMS）III 研究测试了与单独静脉内组织型纤溶酶原激活剂（tPA）相比，静脉内 tPA 后进行血管内治疗的效果，并收集成本数据以评估这两种治疗方法的经济意义。本报告描述了影响美国急性卒中患者初始住院费用的因素。
对 IMS III 试验中接受单独静脉内 tPA 或静脉内 tPA 后进行血管内治疗的美国受试者进行前瞻性成本分析。结果与预期的医疗保险支付进行比较。
在研究中，接受血管内治疗的患者的卒中入院调整后费用为接受静脉内 tPA 后接受血管内治疗的患者为 35130 美元，单独接受静脉内 tPA 治疗的患者为 25630 美元（P<0.0001）。与成本相关的显著因素包括治疗组、基线国立卫生研究院卒中量表、卒中发病至静脉内 tPA 的时间、年龄、卒中部位和合并糖尿病。作为血管内治疗常规使用的全身麻醉的患者的平均费用为 46444 美元，而未使用全身麻醉的患者为 30350 美元。IMS III 患者和国家住院患者样本队列中的患者的取栓术成本超过了医疗保险诊断相关组的支付，在≥75%的患者中。
尽量减少开始静脉内 tPA 的时间并减少常规全身麻醉的使用可能会提高急性卒中的药物和血管内治疗的成本效益。
