Demaerschalk, Bart M.

Background and Purpose— Health economic analyses of intravenous tissue plasminogen activator (tPA) in acute ischemic stroke reveal a substantial cost savings. Unfortunately, tPA is vastly underused. The purpose of this study was to determine the economic impact of increasing tPA utilization in the United States. Methods— Annual incidence estimates of ischemic stroke in the United States and individual states were obtained. The proportion of all ischemic stroke patients who receive tPA was derived from published data. Economic analyses that report the expected annual cost savings of tPA were consulted. The analysis was conducted from the perspective of the healthcare system over a time period of 1 year. With incremental increases in the proportion of all ischemic stroke patients treated with tPA, potential cost savings were recalculated. The outcomes are expressed in dollars saved annually. Results— There are 616 000 new ischemic stroke patients annually. A $600 net cost savings is associated with each tPA-treated patient. Currently, an estimated 2% of all ischemic stroke patients receive tPA. If the proportion was increased to 4, 6, 8, 10, 15, or 20%, the realized cost savings would be approximately $15, 22, 30, 37, 55, and 74 million, respectively. Conclusions— If even small manageable increases in the proportion of all ischemic stroke patients who received tPA were achieved, it would result in an enormous realized savings for America’s healthcare system.