Cost analysis : switching from alteplase to tenecteplase for management of acute ischemic stroke

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King, Claire Mary Rose

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Background: Acute ischemic stroke (AIS) occurs due to obstructed blood flow into blood vessels to the brain and is considered a medical emergency. Thrombolytic therapy is the mainstay of AIS's acute management due to its benefit in improving neurological function within three months. Alteplase is a tPA approved for the treatment of AIS and is widely studied. Tenecteplase is another tPA approved for the treatment of Acute Myocardial Infarction (AMI) but not AIS. Although tenecteplase is not FDA-approved for AIS, it has theoretical advantages over alteplase, such as cost savings.

Methods: Estimated cost savings in the form of avoided costs due to a reduction in hospital days, ICU days, emergency department (ED) visits and tPA costs as a consequence of moving from the current standard of care (SoC), alteplase, to the new drug scenario, tenecteplase, for patients with AIS were analyzed based on hospital claims data.

Results: A total of 336 patients received alteplase (n = 166) or tenecteplase (n = 170) between August 2018 to August 2020. There was no significant difference in the hospital, ICU, inpatient and emergency department (ED) length of stay between the tenecteplase and alteplase groups. The estimated annual savings to Ascension for switching from tenecteplase to alteplase for the management of AIS was $563,001. The cost per patient was lower for patients treated with tenecteplase ($9,969) then alteplase ($13,054), resulting in a savings of $3,065 per patient.

Conclusions: Tenecteplase is less expensive, easier to dose and administer, and may have less adverse events such as bleeding complications than alteplase. Thus, hospitals should consider using tenecteplase rather than alteplase for thrombolysis of acute ischemic stroke.


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