Alteplase Cost Containment Initiative

Purpose: Alteplase is the only FDA approved drug for the treatment of acute ischemic stroke and improves long term neurological outcomes in this patient population. Due to high acquisition cost, pharmacy drug expenditure can be significantly impacted with its use. The purpose of this IRB reviewed study was to identify potential areas where alteplase use may be further optimized to reduce waste. 

Methods: A retrospective review of acute ischemic stroke patients that received intra-arterial and/or intravenous ( IV) alteplase between May 2010 and May 2011 identified opportunities for a potential cost savings of ~ $19,000.  These opportunities included using alteplase 2 mg vials in place of 50 mg vials in the interventional neurology suite and also for IV doses within 6 mg of a 50 mg dose to avoid opening a second vial. Utilizing the manufacturer replacement program when applicable provided further savings. Nurses, pharmacy staff, and physicians were educated about the implementation of cost containment initiatives.  Cost savings data collection started October 2011.

Results: Nine patients received intra-arterial alteplase and 2 mg vials were used instead of 50 mg vials for a cost savings of ~$18,141.  Three patients total IV alteplase doses were within 6 mg of a 50 mg vial and the 2 mg vial was utilized instead of opening a second 50 mg vial.  This resulted in a cost savings of ~$6,366.  Seven 50 mg alteplase vials met criteria and were replaced through the manufacturer replacement program for a cost savings of ~$16,478. The total amount saved from October 2011-May 2012 was ~$40,985.

Conclusion: Small initiatives and education can impact cost savings associated with alteplase.