Costos de atención de los pacientes con ataque cerebrovascular isquémico agudo tratados con terapia de reperfusión endovenosa y los de aquellos que no son tratados con esta terapia en una institución de III nivel en Bogotá en el año 2020

Abstract

Introduction: Ischemic cerebrovascular attack (CVA) is defined as the rapid development of focal or global clinical signs, arising as a consequence of brain dysfunction, the product of a vascular alteration that causes damage to the brain structure. It represents the second cause of death in the world, the main cause of disability in adults and implies high costs in its management and rehabilitation. Objective: To estimate the costs of in-hospital care for patients with acute ischemic stroke treated with endovascular reperfusion therapy and those who are not treated with this therapy in a level III hospital in the city of Bogotá in 2020. Methods: Study of cost-effectiveness type economic evaluations, based on a real cohort of 123 patients from a hospital institution in the city of Bogotá, who presented stroke during 2020, the probabilities of efficacy events and in-hospital clinical outcomes were taken of medical records and were amplified to cohorts of equal weight for analysis, taking into account intravenous thrombolysis and compassionate management as intervention therapy. For the calculation of costs, the institution's rate manual for the year 2020 was used. Results: The cost of thrombolyzed patients during the time of hospital stay considering bleeding events was COP $ 13,412,625,650 and $ 7,866,559,572 for patients who only received compassionate management. The cohort of patients who received thrombolytic therapy presented more bleeding events (14.3% vs 6.8%) but fewer deaths (16.7% vs 18.9%), with a higher frequency of mRankin 0-2 (53% vs 43.3%) and a lower frequency of mRankin 3-5 (30.2% vs 37.7%). Conclusions: Achieving therapeutic goals in patients with stroke implies a high cost of initial in-hospital care and an increased risk of bleeding events, however, better clinical outcomes could mean a lower cost of rehabilitation in the medium and long term, a better quality of life and independence of the patient.