Table 3.
Treatment costs and adverse event management costs.
| TREATMENT COSTS | Units | Unit cost | Final cost | |
|---|---|---|---|---|
| Mechanical thrombectomy | ||||
| Materials (number of units needed for the intervention) | ||||
| Stent retriever (Solitaire) | 1.2 | €3,300.00 | €3,960.00 | |
| Guidewire (Avigo) | 1.0 | €312.00 | €312.00 | |
| Intracranial catheter (Navien)/Balloon guide catheter (Cello) | 1.1 | €630.00 | €693.00 | |
| Microcatheter (Rebar) | 1.1 | €656.24 | €721.86 | |
| Introducer | 1.0 | €200.00 | €200.00 | |
| Procedure packa | 1.0 | €30.00 | €30.00 | |
| Gloves | 2.0 | €0.50 | €1.00 | |
| Diagnosis catheter | 1.0 | €56.42 | €56.42 | |
| Contrast | 1.0 | €77.04 | €77.04 | |
| PTA balloon catheter | 0.2 | €564.20 | €112.84 | |
| Carotid stent | 0.1 | €1,129.00 | €112.90 | |
| Personnel (number of hours of personnel needed for the intervention) | ||||
| Anaesthetist | 2.0 | €35.00 | €70.00 | |
| Interventional neuroradiologist | 3.0 | €35.00 | €104.99 | |
| Neurologist | 2.0 | €35.00 | €70.00 | |
| Resident doctor | 2.0 | €12.15 | €24.29 | |
| Nurse | 6.0 | €21.29 | €127.73 | |
| Tests (number of tests required) | ||||
| Cranial computerised tomography scan | 1.0 | €82.04 | €82.04 | |
| Computerised tomography angiography | 1.0 | €270.07 | €270.07 | |
| Total |
€7,026.17 | |||
| IV t-PA thrombolysis |
||||
| Materials (number of units needed for the intervention) | ||||
| Alteplase (0.9 mg/kg; average patient weight, 75 kg) | €643.68 | |||
| Personnel (number of hours of personnel needed for the intervention) | ||||
| Neurologist | 1.0 | €35.00 | €35.00 | |
| Resident doctor | 3.0 | €12.15 | €36.44 | |
| Nurse | 4.0 | €21.29 | €85.15 | |
| Nursing assistant | 1.0 | €12.64 | €12.64 | |
| Tests (number of tests required) | ||||
| Cranial computerised tomography scan | 1.0 | €82.04 | €82.04 | |
| Computerised tomography angiography | 0.5 | €270.07 | €135.03 | |
| Total |
€1,029.98 | |||
| Non-thrombolytic treatment |
||||
| Personnel (number of hours of personnel needed for the intervention) | ||||
| Neurologist | 0.5 | €35.00 | €17.50 | |
| Resident doctor | 1.0 | €12.15 | €12.15 | |
| Nurse | 2.0 | €21.29 | €42.58 | |
| Interventional neuroradiologist | 0.5 | €35.00 | €17.50 | |
| Tests (number of test required) | ||||
| Cranial computerised tomography scan | 1.0 | €82.04 | €82.04 | |
| Blood test | 1.0 | €44.59 | €44.59 | |
| Transcranial duplex | 1.0 | €128.00 | €128.00 | |
| Electrocardiogram | 1.0 | €38.94 | €38.94 | |
| TREATMENT COSTS |
Units | Unit cost | Final cost | |
| Chest radiograph | 1.0 | €25.71 | €25.71 | |
| Computerised tomography angiography | 0.5a | €270.07 | €135.03 | |
| Perfusion computerised tomography | 0.33 | €243.88 | €80.48 | |
| Total |
|
|
|
€624.50 |
| ADVERSE EVENT MANAGEMENT COSTS |
Units | % patients | Unit cost | Final cost |
| Symptomatic intracranial haemorrhage | ||||
| Specialist visits | ||||
| Neurologist | 10.0 | 100.0 | €138.22 | €1,382.23 |
| Anaesthesiology/Intensive Care | 5.0 | 50.0 | €57.04 | €142.60 |
| Neurosurgery | 1.0 | 25.0 | €151.99 | €38.00 |
| Haematology | 1.0 | 100.0 | €110.34 | €110.34 |
| Rehabilitation/Physiotherapy | 90.0 | 75.0 | €53.97 | €3,642.98 |
| Nutrition | 2.0 | 50.0 | €82.75 | €82.75 |
| Speech therapy | 4.0 | 25.0 | €65.52 | €65.52 |
| Tests | ||||
| Cranial CT scan | 2.0 | 100.0 | 153.00 | €306.01 |
| Hospital admissions | ||||
| Intensive Care Unit | 5.0 | 50.0 | €1,127.71 | €2,819.28 |
| Stroke Unit | 3.0 | 75.0 | €559.81 | €1,259.57 |
| Neurology Unit | 7.0 | 100.0 | €559.81 | €3,918.67 |
| Interventions | ||||
| Craniectomy | 1.0 | 5.0 | €20,190.42 | €1,009.52 |
| Haematoma removal surgery | 1.0 | 25.0 | €2,637.20 | €659.30 |
| Ventricular drain placement | 1.0 | 10.0 | €314.25 | €31.42 |
| Pharmaceutical treatment | ||||
| Intravenous labetalol (300 mg/day) | 3.0 | 50.0 | €0.03 | €11.75 |
| Intravenous urapidil (250 mg/day) | 3.0 | 50.0 | €0.05 | €20.09 |
| Total |
€15,500.02 | |||
| Malignant cerebral oedema requiring haemicraniectomy |
Total cost | |||
| ICD-9-CM 384.5 – cerebral oedema | €4,922.98 | |||
| Craniotomy (age >17 without major complications) | €11,048.15 | |||
| Total | €15,971.13 | |||
CT: computed tomography; IV t-PA: intravenous tissue plasminogen activator; PTA: percutaneous transluminal angioplasty.
a
It is estimated that half of the patients will not respond to IV t-PA and physicians will want to rule out a large arterial occlusion by performing a computerised tomography angiography.