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The mission of the Harvey L. Neiman Health Policy Institute® is to establish foundational evidence for health policy and radiology practice that promotes the effective and efficient use of health care resources and improves patient care.

November 3, 2022

Stroke Treatment, not Neuroimaging, Drives Stroke Hospital Cost Growth

A study by the Neiman Health Policy Institute found that the costs of an Ischemic Stroke (IS) episode increased 4.9% from 2012 to 2019. However, the main driver of those costs was changes in treatments, such as endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT); increases in various types of neuroimaging were not key cost drivers. Over the study period, the share of episodes with treatment increased 155% from 7.3% to 18.5%. There were increases of 80% and 476% in the number of episodes with IVT-only or EVT (with or without IVT), respectively. IVT-only remained the most common treatment, but its treatment share declined from 81.1% of episodes with treatment in 2012 to 57.2% in 2019. “Despite these substantially higher treatment rates, median costs remarkably only increased 4.9% in inflation adjusted dollars” said Eric Christensen, PhD, Director of Economics and Health Services Research at the Neiman Institute. “If the treatment rate had remained at 2012 levels, the estimated costs would have decreased 6.8% between 2012 and 2019, all else equal.”

During the study period of 2012 to 2019, median hospital length of stay dropped 5 days to 4 days, and while-in-hospital mortality rates fell from 6.3% to 4.1%. These improved outcomes also reduced overall costs for each episode, offsetting some of the increase in treatment cost. The study of 75,525 patients with IS used the Medicare 5% Research Identifiable Files (2012-2019) from the Centers for Medicare and Medicaid Services. “To our knowledge, no study has examined the relative contribution of treatment and neuroimaging on ischemic stroke hospital costs over the period in which consensus statements, recommendations, and guidelines changed for stroke treatment,” said lead researcher Pina Sanelli, MD, MPH, FACR, Professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. “Hence, our objective was to examine the association of treatment and neuroimaging with IS total hospital cost growth for the Medicare fee-for-service population.”

The five most significant predictors of higher episode costs were treatment with EVT, longer hospital stays, arrival by transfer, severe stroke, and treatment with IVT. The results do not support that imaging is a primary hospital cost driver between 2012 and 2019. “Fortunately, given the improvements in stroke treatment and the associated reductions in post-treatment costs that muted cost growth that we observed, it appears stroke cost growth between 2012 and 2030 may be less than projected,” said Executive Director of the Neiman Institute, Elizabeth Rula, PhD.

To obtain a copy of the Journal of the American College of Radiology (JACR) study or to arrange an interview with a spokesperson, contact Nichole Gay at (703) 648-1665 or




About the Harvey L. Neiman Health Policy Institute

The Harvey L. Neiman Health Policy Institute is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care. Visit us at and follow us on TwitterLinkedIn and Facebook.



Nichole Gay
Harvey L. Neiman Health Policy Institute