Abstract WMP52: Reduced Hospital Costs For Ischemic Stroke Treated With Tenecteplase

Introduction: Randomized trial evidence and data emerging from routine use support the non-inferiority on clinical outcomes of tenecteplase (TNK) compared to alteplase (ALT) for ischemic stroke thrombolysis. The lower cost of TNK is another potential advantage. We evaluated the hospital costs associated with either drug in a regional stroke network that switched to TNK. Methods: Our 10-hospital stroke network adopted TNK as local standard of care in September 2019. We previously reported clinical outcomes for TNK after 15 months (n=234) to the two prior years of ALT (n=354) using our regional REDCap stroke registry. The current analysis linked these registry patients to the hospital cost accounting system to compare cost categories between the two groups. Results: Table 1 shows the hospital costs overall and by hospital category. Total costs were greater for the ALT group: median (IQR) $15,841 (12,300, 22,323) for ALT vs $13,382 (10,686, 20,636) for TNK (p<0.001). The greatest difference was in total Pharmacy costs $9,288 (8,657, 11,751) vs $6,997 (6,460, 7,972), p<0.001. Table 2 shows the overall costs savings and higher net clinical benefit (% patients with good outcome minus % with poor outcome) seen at hospital discharge associated with TNK use. Discussion and Conclusion: In our regional hospital network after 15 months, TNK thrombolysis of stroke was associated with reduced overall costs, driven primarily by Pharmacy costs. An expanded analysis including other markets that switched to TNK in our national hospital system is in progress. If the current results generalize, the savings potential with a switch to TNK as the standard could be substantial for the health care system.