Abstract WP78: The Cost of Alteplase Has More Than Doubled Over the Past Decade
Introduction: Intravenous alteplase (tissue plasminogen activator) has been shown to be cost effective due to savings in long term disability. In October of 2005, an increased DRG payment to hospitals for alteplase treated stroke patients was introduced. We sought to describe the trends in the cost of alteplase over time, in comparison to trends in hospital reimbursement in the United States. Methods: Utilizing publicly available information on the Centers for Medicare and Medicaid Services (CMS) website (www.cms.gov) we obtained CMS quarterly payment amounts between 1/1/2005 10/1/2014 for alteplase, listed as "alteplase recombinant, per mg." CMS payment amounts are the manufacturer's average sales price (ASP) 6% until 4/2014, when it was lowered to 4.3% Estimates for DRG base payments were calculated within MEDPAR for FY 2006 (DRG 559) and 2013 (MS DRGs 61,62, and 63) as: (DRG relative weights) x (standardized operating and capital amount) The Consumer Price Index (CPI) was also queried for all prescription drugs, urban areas, during the same study period as reference. Results: The CMS payment amount for alteplase/mg was $30.50 in 1/2005, and $64.30 in 10/2014. Trends in the CMS payment amounts for alteplase increased by 111% between 2005 2014, shown in the Figure. The CPI for all prescription drugs increased by 30.2% in the same time frame. The base payment for alteplase treated stroke admissions was $11,173 in 2006, and $12,064 in 2013, an 8% increase. Discussion: We found a striking increase in the cost of alteplase over the last decade, with a 100mg vial now with a CMS payment of $6400, a more than 100% increase over ten years. During the same timeframe, the DRG base payment to hospitals increased by only 8% and alteplase cost increased from 27% of the payment in 2006 to 53% in 2013. Researchers and stroke physicians should be aware of these changes in drug costs and their impact on cost effectiveness analyses.