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 acute ischemic stroke patients. We examined IV tPA use among patients aged 18-64 years with a primary diagnosis acute ischemic stroke in the US and inpatient costs per hospitalization by IV tPA use status among these patients. METHODS Using 2010-2013 MarketScan Commercial Claims and Encounters Inpatient Data, we identified 39,149 hospitalizations with a primary diagnosis of acute ischemic 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 ischemic stroke hospitalization were assessed for sub-populations. We examined costs per acute ischemic stroke hospitalization using multivariate regression models controlling for IV tPA status, age, gender, urbanization, geographic region, Charlson Comorbidity Index, length of hospital stays (LOS) and discharge status. RESULTS 2,546 hospitalizations (6.5%) used IV tPA. IV tPA use increased over time (2010 vs. 2013; odds ratio 1.50). Average inpatient costs per acute ischemic stroke hospitalization was $20,331 ($31,369 for IV tPA group, $19,563 for non-tPA group). From multivariate analyses, higher costs per acute ischemic stroke hospitalization 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 increased recent years while the inpatient costs per acute ischemic stroke hospitalization 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.