Clot busting drugs for stroke: advantages and costs
The U.S. health care system could potentially save from $15 million to $70 million each year -- through increased use of clot busters for stroke patients, according to research reported Thursday, Oct. 13, in Stroke: Journal of the American Heart Association.
The clot-busting drug, tissue plasminogen activator (tPA), is the only U.S. Food and Drug Administration (FDA)-approved treatment for use in certain patients suffering from an acute ischemic stroke -- a blood clot blocking blood flow to the brain. Administered within three hours of the onset of symptoms, tPA can break up the clot and ultimately reduce disabilities caused by the stroke.
"By reducing the disability associated with stroke, you can save a tremendous amount of money over the long-term," explains Bart M. Demaerschalk, M.D., assistant professor of neurology in the divisions of Cerebrovascular Diseases and Critical Care Neurology at Mayo Clinic in Arizona.
Such savings, according to Dr. Demaerschalk, are realized through reduced needs for prolonged hospitalization, rehabilitation, nursing home and extended care services. "These savings are far beyond the costs associated with administering the drug," says Demaerschalk.
In a study conducted by Demaerschalk and coauthor Todd R. Yip, M.D., University of Saskatchewan, Department of Physical Medicine and Rehabilitation, of national and state cost savings realized in the first year when tPA is administered, some interesting findings were revealed: .
In 2003, only an estimated 2 percent of all ischemic stroke patients nationwide received tPA, accounting for an approximate $7.4 million dollar savings per year. That savings climbs with each percentage increase in tPA use.
A realistic goal is 20 percent, according to Demaerschalk. "There are stroke centers in metropolitan communities in Canada and the United States that are currently treating up to 20 percent of their ischemic stroke patients with tPA."
In Phoenix, for example, clinicians have created a Metropolitan Matrix of eight Primary Stroke Centers to potentially serve 3.5 million people. Within this Matrix, tPA is administered to about 18 percent of ischemic stroke patients.
The scientists say tPA use may be increased nationwide by:
- increasing public awareness about stroke symptoms and accessing the emergency medical system in the community by dialing 911;
- educating emergency medical services about the importance of transporting patients with acute stroke to designated stroke centers;
- educating emergency clinicians about stroke treatment with tPA;
- increasing the numbers of primary and comprehensive stroke centers;
- further developing the sub-specialty of "vascular neurology";
- improving collaboration between neurology and emergency medicine; and
- reaching out to rural and under-serviced communities via stroke telemedicine networks
Consumers are urged to seek emergency medical attention by dialing 911 as soon as possible if they believe they are having a stroke. The sooner tPA is administered to an eligible patient, the better the chances for recovery - and a bonus is the potential for health care cost savings in the long run, according to Demaerschalk.