Kleindorfer Dawn, Broderick Joseph, Demaerschalk Bart, Saver Jeffrey
From the Department of Neurology, University of Cincinnati, OH (D.K., J.B.); Department of Neurology, Mayo Clinic, Scottsdale, AZ (B.D.); and Department of Neurology, University of California Los Angeles (J.S.).
Stroke. 2017 Jul;48(7):2000-2002. doi: 10.1161/STROKEAHA.116.015822. Epub 2017 May 23.
Intravenous alteplase (tissue-type plasminogen activator) has been shown to be cost-effective because of savings in long-term disability. In October of 2005, an increased DRG payment to hospitals for alteplase-treated stroke patients was introduced. We sought to describe the trends in the cost of alteplase over time, in comparison to trends in hospital reimbursement in the United States.
Using publicly available information on the Centers for Medicare and Medicaid Services (CMS) website (www.cms.gov), we obtained CMS quarterly payment amounts between January 1, 2005, and October 1, 2014, for alteplase, listed as alteplase recombinant, per mg. CMS payment amounts are the manufacturer's average sales price+6% until April 2014, when it was lowered to +4.3%. Estimates for DRG base payments were calculated within the Medicare Provider and Analysis Review (MEDPAR) for fiscal years 2006 (DRG 559) and 2013 (MS DRGs 61, 62, and 63) as (DRG relative weights)×(standardized operating and capital amount). The consumer price index was also queried for all prescription drugs, urban areas, during the same study period as reference.
The CMS payment amount for alteplase per milligram was $30.50 in January 2005 and $64.30 in October 2014. Trends in the CMS payment amounts for alteplase increased by 111% between 2005 and 2014. The consumer price index for all prescription drugs increased by 30.2% in the same time frame. The base payment for alteplase-treated stroke admissions was $11 173 in 2006 and $12 064 in 2013, an 8% increase.
We found a striking increase in the cost of alteplase over the last decade, with a 100 mg vial now with a CMS payment of ≈$6400, a >100% increase over 10 years. During the same time frame, the DRG base payment to hospitals increased by only 8%, and alteplase cost increased from 27% of the payment in 2006 to 53% in 2013. Researchers and stroke physicians should be aware of these changes in drug costs and their impact on cost-effectiveness analyses.
静脉注射阿替普酶（组织型纤溶酶原激活剂）已被证明具有成本效益，因为可节省长期残疾方面的费用。2005年10月，美国引入了针对接受阿替普酶治疗的中风患者增加向医院支付诊断相关分组（DRG）费用的措施。我们试图描述阿替普酶成本随时间的变化趋势，并与美国医院报销趋势进行比较。
利用医疗保险和医疗补助服务中心（CMS）网站（www.cms.gov）上公开的信息，我们获取了2005年1月1日至2014年10月1日期间CMS每毫克阿替普酶（列为重组阿替普酶）的季度支付金额。2014年4月之前，CMS支付金额为制造商平均销售价格加6%，之后降至加4.3%。2006财年（DRG 559）和2013财年（MS DRGs 61、62和63）在医疗保险提供者分析审查（MEDPAR）中计算DRG基础支付额，计算方法为（DRG相对权重）×（标准化运营和资本金额）。在同一研究期间，还查询了所有处方药在城市地区的消费者价格指数作为参考。
2005年1月阿替普酶每毫克的CMS支付金额为30.50美元，2014年10月为64.30美元。2005年至2014年期间，阿替普酶的CMS支付金额趋势增长了111%。同一时间段内，所有处方药的消费者价格指数增长了30.2%。2006年接受阿替普酶治疗的中风住院患者的基础支付额为11173美元，2013年为12064美元，增长了8%。
我们发现过去十年阿替普酶成本显著增加，现在一支100毫克的小瓶CMS支付额约为6400美元，10年间增长超过100%。在同一时间段内，医院的DRG基础支付额仅增长了8%，阿替普酶成本从2006年占支付额的27%增至2013年的53%。研究人员和中风科医生应了解这些药物成本变化及其对成本效益分析的影响。
