Abstract WP296: Direct Cost Savings Associated with Intensive Systolic Blood Pressure Reduction in Patients with Intracerebral Hemorrhage

Abstract

INTRODUCTION: The Antihypertensive treatment of Acute Cerebral Hemorrhage (ATACH) II is determining whether intensive systolic blood pressure (SBP) reduction (SBP ≤140mm Hg) using IV nicardipine initiated within 4.5 hours of onset of intracerebral hemorrhage (ICH) reduces the likelihood of death or disability (modified Rankin scale [mRS] score of 4-6) at 3 months by ≥10% compared with standard SBP reduction (SBP ≤180mm Hg). Objective: To determine the direct cost savings by intensive systolic blood pressure reduction if the 10% reduction in death and disability goals are met in patients with ICH. Methods: The dose and duration of IV nicardipine to achieve different SBP goals were derived from ATACH I and the probability of death or disability were obtained from placebo treated ICH patients recruited in recombinant factor VII trials. Total cost associated with acute hospitalization was derived from Nationwide Inpatient Sample files 2010 for none-mild disability (home discharge considered equivalent to mRS 0-1), moderate disability (in-patient rehabilitation=mRS 2-3), severe disability (nursing home=mRS=4-5), and death. The cost of nursing home stay, in-patient and out-patient rehabilitation services, and physician visits were derived from MetLife Market Survey of Nursing Home and Home Care and Medicare re-imbursement policy. Results: The estimated incremental costs for IV nicardipine for intensive SBP reduction was $85,600 for 100 patients treated. The direct cost of death and disability (cost of acute hospitalization, post-hospital care, and physician visits visit for 90 days) was estimated to be $4,377,142 in 100 patients treated with standard SBP reduction. The cost saving was estimated to be $147,570 if 10% of patients with mRS 4-5 changed to mRS 2-3. The cost saving was estimated to be $357,685 if 10% of patients with mRS 4-5 changed to mRS 2-3 (5%) and mRS 0-1 (5%). The net savings in the first and second scenario were $61,970 and $272,085 per 100 patients treated in the first 90 days, respectively. Conclusions: Intensive SBP reduction in patients with ICH appears to result in prominent cost savings if the ATACH II goals of reduction in death and disability are met.