Tabla I. Variables clínicas, comparación entre grupos. |
|||||
Trombectomía |
Fibrinólisis |
Estadístico |
p |
||
Edad (años) |
70,08 ± 10,91 |
72,52 ± 11,40 |
H = 2,27; gl = 1 |
0,132 |
|
Sexo |
Hombre |
40 (65,57%) |
24 (54,55%) |
χ2 = 1,306; gl = 1 |
0,253 |
Mujer |
21 (34,43%) |
20 (45,45%) |
|||
Diabetes mellitus |
14 (22,95%) |
8 (18,18%) |
χ2 = 0,351; gl = 1 |
0,554 |
|
Dislipidemia |
18 (29,51%) |
14 (31,82%) |
χ2 = 0,064; gl = 1 |
0,800 |
|
Tabaquismo |
26 (42,62%) |
6 (13,64%) |
χ2 = 10,137; gl = 1 |
0,002 |
|
Cardiopatía isquémica |
10 (16,39%) |
7 (15,91%) |
χ2 = 0,004; gl = 1 |
0,947 |
|
Tiempo inicio-aguja (min) |
189,91 ± 71,53 |
156,05 ± 47,21 |
H = 6,45; gl = 1 |
0,011 |
|
NIHSS |
15,69 ± 4,21 |
10,57 ± 5,39 |
T = 5,25; gl = 78 |
< 0,001 |
|
Angiotomografía |
61 (100%) |
28 (63,64%) |
< 0,001 |
||
Escala de Rankin modificada a los 90 días |
≤ 2 |
39 (63,93%) |
25 (56,82%) |
χ2 = 0,544; gl = 1 |
0,461 |
> 2 |
22 (36,07%) |
19 (43,18%) |
|||
Mortalidad a los 90 días |
11 (18,03%) |
5 (11,36%) |
χ2 = 0,880; gl = 1 |
0,348 |
|
Hemorragias intracerebrales |
3 (4,92%) |
0 |
0,263 |
||
gl: grados de libertad; NIHSS: National Institute of Health Stroke Scale. |
Tabla II. Costes de las diferentes variables (euros). |
|
Ingreso en urgencias |
1.541,73 |
Neurólogo (60 min) |
23,84 |
Tomografía computarizada craneal sin contraste |
33,98 |
Angiotomografía cervicocraneal |
167,61 |
Perfusión cerebral por tomografía computarizada |
155,87 |
Ingreso en la unidad de vigilancia intensiva 24 h |
4.706,46 |
Ingreso en la unidad de ictus 24 h |
362,00 |
Ingreso en neurología 24 h |
488,07 |
Ingreso en rehabilitación 24 h |
363,33 |
Primera consulta externa de neurología |
230,00 |
Consulta sucesiva de neurología |
138,59 |
Primera consulta (coste medio) |
162,97 |
Consulta sucesiva (coste medio) |
97,78 |
Sesión de rehabilitación |
14,98 |
Trombectomía |
6.574,18 |
Fibrinólisis |
636,76 |
Tabla III. Costes medios de los pacientes tratados por medio de trombectomía y fibrinólisis (euros). |
||||
Trombectomía |
Fibrinólisis |
Estadístico |
p |
|
Urgencias |
1.541,73 |
1.541,73 |
||
Neurólogo |
23,84 |
23,84 |
||
Fibrinólisis |
0 |
636,76 |
||
Trombectomía |
6.574,18 |
0 |
||
Imagen |
357,45 ± 0 |
239,82 ± 157,40 |
H = 10,04; gl = 1 |
0,002 |
Días de ingreso |
7.360,00 ± 7.097,20 |
5.600,90 ± 3.711,30 |
H = 0,45; gl = 1 |
0,504 |
Consultas |
45,43 ± 84,86 |
44,46 ± 88,68 |
H = 0,002; gl = 1 |
0,897 |
Rehabilitación |
156,15 ± 355,35 |
81,48 ± 282,99 |
H = 0,33; gl = 1 |
0,563 |
Coste total |
16.058,78 ± 7.209,00 |
8.168,99 ± 3.734,30 |
H = 51,41; gl = 1 |
< 0,001 |
gl: grados de libertad. |
Analysis of the direct costs associated with mechanical thrombectomy and intravenous fibrinolysis in the Hospital Universitario Central de Asturias Introduction. The increase in the indications for mechanical thrombectomy and its implementation in Spanish hospitals makes it necessary to determine the costs related to this treatment so as to be able to streamline economic resources and allow them to be distributed in an appropriate manner. Aims. To analyse the direct costs associated with patients with acute ischaemic stroke who are treated with intravenous fibrinolysis and with mechanical thrombectomy, and to assess the effectiveness and safety of both treatments during the first 90 days of progression in the Hospital Universitario Central de Asturias. Patients and methods. A retrospective analysis was performed that included 44 patients who received intravenous fibrinolysis and 61 patients treated with mechanical thrombectomy, in whom a series of clinical and economic variables were analysed. Results. The mean final total cost per patient was 16,059 euros in treatments with thrombectomy and 8,169 euros in those in which intravenous fibrinolysis was administered. The percentage of patients with a good functional prognosis at 90 days was 63.93% in those treated by endovascular means and 56.82% in those who received intravenous fibrinolysis. Mortality rates were 18.03 and 11.36%, respectively. Conclusions. The mean cost of treatment with mechanical thrombectomy, as well as the total mean cost per patient during the acute phase of the disease associated with this technique, is higher than in the case of intravenous fibrinolysis. In our setting, both intravenous fibrinolysis and mechanical thrombectomy are considered to be effective and safe. Key words. Cost. Effectiveness. Fibrinolysis. Stroke. Thrombectomy. Treatment. |