Teleneurology in stroke management: costs of service in different organizational models

Abstract

Telemedicine is in increasing use in clinical neuroscience such as acute stroke care, especially by applying remote audiovisual communication for patient evaluation. However, telephone consultation was also used linking stroke centres to smaller hospitals. We compared costs of telestroke services using audiovisual and telephone communication in different organizational models. Within a small network in Northern Bavaria video-based teleconsultation (VTC) and telephone advice (TA) was provided for evaluation of acute stroke patients on a weekly rotation. The costs of the admissions process with or without one of both methods of telemedicine were calculated and compared from the perspective of the spoke hospital. Different levels of service and network size were modelled and costs of transfers as well as loss of revenues were calculated. Yearly total labour costs were 415,000 € for an on-site service VTC-service compared to 61,000 € in an on-call service. Additional costs for one teleconsultation were 109.55 € in VTC and 49.82 € in TA (VTC/TA ratio 2.2). The ratio decreased to 0.8 when accounting for costs of transfer and loss of reimbursement for all patients transferred as transfer of patients to the stroke centre was more frequent after TA (9.1 vs. 14.9%full-time on-site ser). Costs of one QALY gained by using VTC instead of TA ranged from 115.00 € to 515.86 € depending on the different models. In the first view TA looks like the less expensive method as it is easy to access and works without additional costs. When accounting for all disadvantages TA becomes slightly more expensive. In telestroke care VTC should be recommended as the method of choice also from an economic perspective.

Telemedicine is a useful tool to deliver care to patients with Amyotrophic Lateral Sclerosis during COVID-19 pandemic: results from Southern Italy

“…Telemedicine is a rapidly progressing field that is constantly exploring patient care with the support of multiple applications and services including remote videoconferencing, e-mail, apps and other forms of technology. Teleneurology is an effective tool for the rapid evaluation of patients in remote locations (4) with a well established use in acute stroke (5,6) and epilepsy (7,8) and more recently in neurodegenerative disorders such as Parkinson's Disease (9) and dementia (10)(11)(12).…”

Implementation and Evaluation of an Economic Model for Telestroke: Experience from Virtuall, France

“…Nevertheless, this economic gain is at the expense of a financial burden at the acute phase. Recent studies have estimated that the annual cost for a spoke participating in telestroke is €415,000 ( 14 ). This includes not only the costs related to the telestroke operation itself but also to the loss of hospitalization fees due to the patient being transferred to the hub.…”

New hospital structure in the twenty-first century: the position of level III (tertiary) neurological and stroke care in a changing healthcare system

“…This ensures the desired allocation of resources, which are necessary to provide services of a suitable quality and satisfy the criteria of patient safety. Access to services within an appropriate timeframe can be improved through the support of pre-hospital services, either diagnostic (Handschu et al 2014) or curative (Saifee et al 2013; Weber et al 2013; Audebert et al 2013). …”