A new study has determined that the cost of tissue plasminogen activator (tPA) has “more than doubled” over the last 10 years, while Medicare/Medicaid reimbursement has not followed suit.

The study, presented at the International Stroke Conference 2016, found that the cost of tPA increased by 111% between 2005 and 2014, while Medicare/Medicaid reimbursement increased by only 8%. Researchers assessed publicly available data, evaluating the average sales price of tPA since 2006, comparing the price to the base payment from the Centers for Medicare & Medicaid Services (CMS). In 2005, 1 mg of tPA was priced at $30.50. Dawn Kleindorfer, MD, lead researcher and professor, department of neurology and rehabilitation, University of Cincinnati, stated that the cost of tPA was “relatively stable from 2005 to 2009, when it began to increase over time,” according to a recent article on Medscape.

Data showed that in 2014, 1 mg of tPA rose to $64.30. Dr Kleindorfer explained that this means the standard 100 mg vial of tPA cost an average of $6400 in 2014. “Over the study period, we found an 111% increase in the cost of the medication,” she said. 

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Dr Kleindorfer also stated that during that same time period, the consumer price index for all drugs increased by 30.2%. Additionally, CMS reimbursements to hospitals for patients treated with tPA increased by only 8%—from $11,173 in 2006 to $12,064 in 2013. She added that in 2006, 27% of the total CMS hospital reimbursement amount went to pay for tPA, which is now at 53%.

“The reason that reimbursement has not kept up with the cost is complicated but has to do with the way it’s calculated and the fact that Medicare/Medicaid is cutting hospital reimbursements across the board,” said Dr Kleindorfer, in the Medscape report. “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.”

During the presentation, Dr Kleindorfer noted that despite the low reimbursement rates, tPA is still cost-effective to society. She revealed that, from a policy standpoint, 39 years of quality adjusted life years would be gained and >2.5 million US dollars saved in medical costs for every 100 patients treated with tPA within 0 to 3 hours of acute ischemic stroke onset. She shared that the savings would come from nursing home costs and reduced long-term rehabilitation, but those savings do not address the hospital costs.—Alessia D’Anna

Reference: Brooks M. Cost of thrombolysis outpaces reimbursement in stroke. Medscape. February 23, 2016.