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Updated: Jul 11, 2026
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Cost implications of specialized coagulation testing for acute ischemic stroke
C D Bushnell1, S K Datta, L B Goldstein
1Duke University Center for Cerebrovascular Disease, Durham, NC, USA.
Summary
Evaluating hypercoagulable states in ischemic stroke patients costs $1,102 per additional patient treated with warfarin. Optimizing patient selection for coagulation testing is crucial for cost-effectiveness in stroke management.
Area of Science:
- Neurology
- Hematology
- Health Economics
Background:
- Hypercoagulable states are a rare but significant cause of ischemic stroke.
- Diagnostic evaluation for these disorders can be costly.
- Identifying these states may alter patient treatment strategies.
Purpose of the Study:
- To estimate the incremental cost-effectiveness of specialized coagulation testing.
- To determine the cost per additional ischemic stroke patient treated with warfarin.
Main Methods:
- Cost-effectiveness analysis of 674 adult ischemic stroke patients over 3 years.
- Exclusion of patients with atrial fibrillation or warfarin contraindications.
- Utilized Medicare reimbursement rates for specialized coagulation tests.
Main Results:
- The base case incremental cost-effectiveness ratio (ICER) was $1,102 per additional patient treated with warfarin.
- Sensitivity analyses showed ICERs ranging from $496 to $2,959.
- The proportion of untested patients receiving warfarin significantly impacted the ICER.
Conclusions:
- There is a need for optimized patient selection strategies for specialized coagulation testing.
- Further research is required to determine the impact of secondary prevention with anticoagulation in patients with specific coagulopathies on outcomes-based cost-effectiveness.
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