Thrombolysis for stroke (alteplase) - national tariff uplift

NICE works with the Department of Health's payment by results team to identify the best way to ensure the cost of implementing NICE guidance is reflected in the tariff. In the past, where variation in uptake of high cost drugs may occur it has been the PBR team's policy to exclude the drug cost and leave it to providers and commissioners to agree funding mechanisms locally.

For 2008/09, the national tariff has a specific NICE uplift, called Thrombolysis for Stroke (Alteplase). This is to recognise the additional costs incurred in the administration of alteplase, and so adequately reward those trusts who administer alteplase in the treatmet of an acute ischaemic stroke removing the need for local negotiation.

When, as part of an admitted patient exercise, alteplase is administered in line with TA122, Ischaemic stroke (acute) - alteplase, this should be coded by the clinical coding team with OPCS code X83.3 (Fibrinolytic drugs). The grouping software will then automatically allocate a specialised service code of 97 to the admitted patient spell, provided the final spell is A22 (Non-Transient Stroke or Cerebrovascular Accident >69 or w cc) or A23 (Non-Transient Stroke or Cerebrovascular Accident <70 w/o cc). The PCT will then pay the additional top-up of 23% (around £814 per patient), without any additional administrative processes by the Trust.

Costing tools developed for alteplase at the time the guidance was issued can be found here. Organisations may wish to revisit these and amend the local assumptions to reflect the NICE uplift.

NICE welcomes feedback on any of our costing tools. Please send feedback to costing@nice.org.uk.