Pharmacoeconomic impact of an alternative workflow process for stroke

Area of Science:

• Neurology
• Emergency Medicine
• Health Economics

Background:

• Acute ischemic stroke (AIS) treatment relies on timely administration of intravenous alteplase (tPA).
• Unused tPA represents a significant cost and potential waste in emergency departments.
• Optimizing resource utilization is crucial for cost-effective healthcare delivery.

Purpose of the Study:

• To evaluate a novel multidisciplinary process for salvaging intravenous alteplase (tPA) waste.
• To assess the impact of this process on cost-effectiveness without compromising door-to-needle (DTN) times.
• To determine the potential for significant annual cost savings through tPA waste recovery.

Main Methods:

• Retrospective cohort study conducted between May 2017 and February 2018 at a primary stroke center's emergency department.
• Implementation of a new process involving bedside mixing of tPA and salvaging of excess waste in the central pharmacy.
• Analysis of 50 adult patients receiving tPA for AIS, comparing a group under the new process (n=25) with a historical control group (n=25).

Main Results:

• The new process successfully salvaged 605 mg of alteplase from 25 patients, yielding estimated annual cost savings exceeding $120,000.
• Patients in the new process group exhibited statistically significant faster average DTN times (52 min vs. 60 min, p=0.01).
• Median DTN times were also improved in the new process group (50 min vs. 58 min, p=0.03).

Conclusions:

• A multidisciplinary model for tPA administration, incorporating waste salvaging, led to substantial cost savings.
• This innovative approach also resulted in decreased overall door-to-needle administration times.
• Preliminary findings suggest this pilot study's model is effective for both economic and clinical efficiency in AIS management.