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NEW ORLEANS -- Tenecteplase in recent years outpaced alteplase as the stroke thrombolytic of choice at one large hospital system, despite shrinking cost savings, a researcher reported here.

In 2021, clinicians at Cardinal Health-managed and consulting hospitals used alteplase almost exclusively for acute ischemic stroke. But the tide turned to tenecteplase from 2022 to 2024 following publication of studies supporting its use, reported Dustin Spencer, PharmD, MBA, a clinical director of cardiopulmonary and critical care at Cardinal Health in Houston.

Clinicians at the health system had been given a review of literature supporting tenecteplase in December 2021, and pharmacy and therapeutics committees at these hospitals decided whether or not to use the drug for stroke thrombolysis.

During the transition, the cost per patient day for tenecteplase increased from $0.12 in 2021 to $2.21 in 2022-2024 (P<0.0001). The average cost for alteplase did not rise significantly in this timeframe (from $1.28 to $1.75, P=0.096), according to findings presented at the American Society of Health-System Pharmacists midyear meeting.

Compared to alteplase, the authors noted, tenecteplase has higher fibrin specificity, a longer half-life, and a simpler, single-bolus administration rather than infusion. Total annual cost savings with tenecteplase, the analysis found, were about $1.27 million for the hospital system in 2023.

"It's easier to administer and it is cheaper," Spencer told MedPage Today. "Unfortunately, the cost of tenecteplase has been going up each year, so it's getting closer and closer to the cost of alteplase."

Both drugs are tissue plasminogen activators, but alteplase is the only FDA-approved thrombolytic for ischemic stroke. Tenecteplase is approved for acute ST elevation myocardial infarction, but several studies have recently established it as effective for improving neurologic function after ischemic stroke.

It's unlikely that Genentech -- the manufacturer of both drugs -- will seek approval for this indication, however.

"Even though there's data, the company has no incentive to go to the FDA and get an indication for it. Everyone's using it already for stroke, so they have no reason to go and get that indication," Spencer said.

"They're just getting clued in to the fact that people are starting to use it," Spencer added. "They're increasing the price, so we're not sure how long we'll be able to realize any savings from it."

For their study, Spencer and colleagues analyzed data from January 2021 through August 2024, before and after the literature was distributed across Cardinal Health. An internal drug cost analytics program was used to gather data from hospitals on thrombolytic utilization, patient days, costs, and coding.

In all, 3,582 patients from 73 hospitals had data available and were included.

Wholesale acquisition costs were used for cost calculations in order to account for varying contract prices across hospitals.

Study limitations included the dataset being limited to one hospital system. The study also did not report on patient demographics or clinical outcomes of tenecteplase versus alteplase.

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