Navigating the Shift: Comparing Safety and Cost of Tenecteplase versus Alteplase in Acute Ischemic Stroke

Recently, institutions have been transitioning to tenecteplase (TNK) as the primary agent for stroke management instead of alteplase (tPA) due to its comparable safety and cost-effectiveness. Despite TNK's potential cost benefits, there's limited literature on how wasted doses impact the overall cost. This study aimed to compare the safety and cost of TNK to tPA following the transition to TNK as the primary agent for acute ischemic stroke (AIS) management at a community hospital.

This retrospective study compared patients treated with tPA or TNK for AIS. The primary outcome was a composite of intracranial hemorrhage, any other bleed, and death from any cause. Secondary outcomes included the individual components of the primary outcome, length of hospitalization, time from administration decision to medication administration, readmission rate, medication costs, and wasted doses.

48 AIS patients who received either tPA or TNK between November 2021 and February 2024 were included. TNK didn't result in more occurrences of the primary outcome compared to tPA (OR 1.00, 95% CI 0.25 to 4.03). The TNK group had a shorter median length of hospitalization and decreased elapsed time from administration decision to administration. The cost difference between a 50 mg kit of TNK and a 100 mg vial of tPA is about $1100. The total number of wasted doses was 10 for tPA and 12 for TNK.

There was no difference in safety between TNK and tPA. While TNK offers cost savings, poor waste management could undermine its overall cost-effectiveness.