BACKGROUND AND PURPOSE: Anterior circulation large-vessel occlusion stroke, one of the most devastating stroke subtypes, is associated with substantial economic burden. We aimed to identify predictors of increased acute care hospitalization costs associated with anterior circulation large-vessel occlusion stroke. MATERIALS AND METHODS: Comprehensive cost-tracking software was used to calculate acute care hospitalization costs for patients with anterior circulation large-vessel occlusion stroke admitted July 2012 to October 2014. Patient demographics and stroke characteristics were analyzed, including final infarct volume on follow-up neuroimaging. Predictors of hospitalization costs were determined using multivariable linear regression including subgroup cost analyses by treatment technique (endovascular, IV tPA-only, and no reperfusion therapy) and sensitivity analyses incorporating patients initially excluded due to early withdrawal of care. RESULTS: Three hundred forty-one patients (median age, 69 years; interquartile range, 57- 80 years; median NIHSS score, 16; interquartile range, 13-21) were included in our primary analysis. Final infarct volume, parenchymal hematoma, baseline NIHSS score, ipsilateral carotid stenosis, age, and obstructive sleep apnea were significant predictors of acute care hospitalization costs. Final infarct volume alone accounted for 20.87% of the total cost variance. Additionally, final infarct volume was consistently the strongest predictor of increased cost in primary, subgroup, and sensitivity analyses. CONCLUSIONS: Final infarct volume was the strongest predictor of increased hospitalization costs in anterior circulation large-vessel occlusion stroke. Acute stroke therapies that reduce final infarct volume may not only improve clinical outcomes but may also prove cost-effective.
Bibliographical noteFunding Information:
Disclosures: Christopher D. Streib—RELATED: Grant: National Institutes of Health StrokeNet, Comments: National Institutes of Health StrokeNet Fellowship grant University of Pittsburgh (1U01NS086489–02).* Srikant Rangaraju—UNRELATED: Grants/Grants Pending: National Institutes of Health/National Institute of Neurological Disorders and Stroke K08.* Daniel G. Winger—RELATED: Grant: National Institutes of Health, Comments: The project described was supported by the National Institutes of Health through grant number UL1-TR-000005.* Tudor G. Jovin— UNRELATED: Consultancy: Cerenovus, Biogen; Stock/Stock Options: Anaconda, Silk Road, Route 92, Blockade Medical, FreeOx Biotech. Brian T. Jankowitz—UNRELATED: Consultancy: Stryker, Medtronic; *Money paid to the institution.
Received April 26, 2018; accepted after revision October 21. From the Department of Neurology (C.D.S., A.J.Z.), University of Minnesota, Minneapolis, Minnesota; Department of Neurology, Stroke Institute (C.D.S., S.L.P., B.T.J., A.P.J., T.G.J., S.R., D.T.C.), University of Pittsburgh Medical Center, Pittsburgh. Pennsylvania; Department of Neurology (S.R.), Emory University, Atlanta, Georgia; Department of Neurology (D.T.C.), WellStar Kennestone Hospital, Marietta, Georgia; and Clinical Translational Science Institute (D.G.W.), University of Pittsburgh, Pittsburgh, Pennsylvania. Dr Streib was a NIH StrokeNET fellow supported by 1U01NS086489–02 (Principal Investigator Tudor G. Jovin and Lawrence Wechsler). Dr Rangaraju was a National Institutes of Health StrokeNET fellow supported by 1U10NS086607–01 (Principal Investigator, Michael Frankel) and is also a recipient of a clinical research training fellowship from the American Brain Foundation. This project was supported by the National Institutes of Health through grant No. UL1-TR-000005.