Estimated cost savings of increased use of intravenous tissue plasminogen activator for acute ischemic stroke in Canada

BACKGROUND AND PURPOSE - Intravenous tissue plasminogen activator (tPA) is an economically worthwhile but underused treatment option for acute ischemic stroke. We sought to identify the extent of tPA use in Canadian medical centers and the potential savings associated with increased use nationally and by province. METHODS - We determined the nationwide annual incidence of ischemic stroke from the Canadian Institute of Health Information. The proportion of all ischemic stroke patients who received tPA was derived from published data. Economic analyses that report the expected annual cost savings of tPA were consulted. The analysis was conducted from the perspective of a universal health care system during 1 year. We estimated cost-savings with incrementally (eg, 2%, 4%, 6%, 8%, 10%, 15%, and 20%) increased use of tPA for acute ischemic stroke nationally and provincially. RESULTS - The current average national tPA utilization is 1.4%. For every increase of 2 percentage points in utilization, $757 204 (Canadian) could possibly be saved annually (95% CI maximum loss of $3 823 992 to a maximum savings of $2 201 252). With a 20% rate, >$7.5 million (Canadian) could be saved nationwide the first year. CONCLUSIONS - We estimate that even small increases in the proportion of all Canadian ischemic stroke patients receiving tPA could result in substantial realized savings for Canada's health care system.