Cost of clot-busting altepase outpaces US reimbursement

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The cost of altepase has more than doubled over the past ten years in the USA, whilst US Medicare/Medicaid reimbursement has lagged far behind, a presentation from the American Stroke Association’s International Stroke Conference (ISC 2016) has reported.

Altepase is the only drug for patients with stroke caused by blocked blood vessels approved by the US Food and Drug Administration (FDA). Altapase contains a clot-busting recombinant tissue plasminogen activator.

“Stroke healthcare professionals really need to be aware of the costs of the therapies they’re providing,” says Dawn Kleindorfer, lead researcher and professor in the Neurology and Rehabilitation Department, University of Cincinnati, Ohio, USA. “When the infrastructure is not adequately reimbursing, it should be a call to action for healthcare professionals to lobby the Centers for Medicare and Medicaid Services to better adjust for these higher-cost medications so we can take good care of our patients.”

In this study, researchers found that the cost of alteplase increased by 111% between 2005 and 2014. In 2005, one milligram of the drug cost US$30.50, compared to US$64.30 in 2014. In other words, a standard 100-milligram vial of alteplase cost about $6,400 in 2014.

At the same time, the amount that the Centers for Medicare and Medicaid Services reimbursed to hospitals for alteplase-treated patients increased by only 8%. According to the to the researchers, this means that roughly half of the reimbursement dollars now go to pay for the drug, while the other half covers everything else related to hospitalisation, including diagnostic testing, bedside care, and other hospital costs. For their analysis, the researchers used cost information that is publicly available on the Centers for Medicare and Medicaid Services website.

“The reason the cost has gone up so much is unclear,” Kleindorfer says. “The reason that reimbursement has not kept up with the cost is complicated, but has to do with the way it is calculated, and the fact that Medicare/Medicaid is cutting hospital reimbursements across the board. What we need to do is ensure that the reimbursement covers the cost of caring for these patients so that hospitals don’t lose money while providing this proven beneficial treatment.”

A limitation is that the study used the drug manufacturer’s average sales price, which may vary between different hospitals. Also variable is the reimbursement amount from private insurers.