Telemedicine for Stroke: Quantifying the Long-Term National Costs and Health Benefits

Abstract

ObjectiveFew countries have established national programs to maximize access and reduce operational overheads. We aimed to use patient-level data up to 12 months to model the potential long-term costs and health benefits attributable to implementing such a program for Australia.MethodsA Markov model was created for Australia with an inception population of 10,000 people with stroke presenting to non–urban or suburban hospitals without stroke medical specialists that could receive stroke telemedicine under a national program. Seven Markov states represented the seven modified Rankin Scale (mRS) scores (0 no disability to 6 dead) plus an absorbing state for all other causes of death. The literature informed data for the model; for the telemedicine program (including program costs and effectiveness) and patients, these were extrapolated from the Victorian Stroke Telemedicine (VST) program with the initial status of patients being their health state at day 365 as determined by their mRS score study. Costs (2018 Australian dollars, healthcare, non–medical, and nursing home) and benefits were reported for both the societal and healthcare perspectives for up to a 25-years (lifetime) time horizon.ResultsWe assumed 4,997 to 12,578 ischemic strokes would arrive within 4.5 h of symptom onset at regional hospitals in 2018. The average per person lifetime costs were $126,461 and $127,987 from a societal perspective or $76,680 and $75,901 from a healthcare system perspective and benefits were 4.43 quality-adjusted life years (QALYs) and 3.98 QALYs gained, respectively, for the stroke telemedicine program and practice without such program. The stroke telemedicine program was associated with a cost saving of $1,526 (from the societal perspective) or an additional $779 (from the healthcare system perspective) and an additional 0.45 QALY gained per patient over the lifetime. The incremental costs of the stroke telemedicine program ($2,959) and management poststroke ($813) were offset by cost savings from rehospitalization (–$552), nursing home care (–$2178), and non–medical resource use (–$128).ConclusionThe findings from this long-term model provide evidence to support ongoing funding for stroke telemedicine services in Australia. Our estimates are conservative since other benefits of the service outside the use of intravenous thrombolysis were not included.

Systematic Review of Economic Evaluation Studies of Stroke Disease: Cost Effectiveness

“…In Table 2. Societal perspective is used for hospital respondents setting studies 15,16,19,20,24 . The payer perspective was taken from national institutes; ambulance services; national health system; and public healthcare setting studies 17,18,[21][22][23] .…”

“…As one of the high-income countries, Brazil used the highest differentiation rate (5%) 23 . While using the cohort study method, Kim and Gao had the longest time frame 15,16 .…”

“…Furthermore, there are 13 articles included in this review. The included studies were conducted with 2 citations from Australia 15,16 , 3 citations from United Kingdom [17][18][19] , 1 citation from Chicago, 1 citation from Saudi Arabia 20 , 1 citation from French 21 , 1 citation from Spain 22 , 1 citation from Brazil 23 , 1 citation from China 9 , 1 citation from Thailand 24 . Of these, the base year for costing is different and adapts to the setting of places and purpose of study.…”

Custo-efetividade da telemedicina no tratamento do acidente vascular cerebral isquêmico agudo na Irmandade da Santa Casa de Misericórdia de Matão-SP

“…Analisando o subgrupo de pacientes sem FA, a TNM se mostrou custo-efetiva junto ao tratamento do AVCi no HCFM, mesmo em contexto de pandemia. Esses resultados corroboram o que se verifica internacionalmente: aumento de trombólises e custo-efetividade dos serviços de teleneurologia (WALLUT et al, 2020;TAN et al, 2021;GAO et al, 2022;AFOLABI et al, 2023). Além disso, não é uma tecnologia de alto custo e não é difícil de replicar, dada a notória ampla disponibilidade de aparelhos celulares.…”