The cost-effectiveness of telestroke in the treatment of acute ischemic stroke

Abstract

Objective: To conduct a cost-effectiveness analysis of telestroke-a 2-way, audiovisual technology that links stroke specialists to remote emergency department physicians and their stroke patients-compared to usual care (i.e., remote emergency departments without telestroke consultation or stroke experts). Methods:A decision-analytic model was developed for both 90-day and lifetime horizons. Model inputs were taken from published literature where available and supplemented with western states' telestroke experiences. Costs were gathered using a societal perspective and converted to 2008 US dollars. Quality-adjusted life-years (QALYs) gained were combined with costs to generate incremental cost-effectiveness ratios (ICERs). In the lifetime horizon model, both costs and QALYs were discounted at 3% annually. Both one-way sensitivity analyses and Monte Carlo simulations were performed. Results:In the base case analysis, compared to usual care, telestroke results in an ICER of $108,363/QALY in the 90-day horizon and $2,449/QALY in the lifetime horizon. For the 90-day and lifetime horizons, 37.5% and 99.7% of 10,000 Monte Carlo simulations yielded ICERs Ͻ$50,000/QALY, a ratio commonly considered acceptable in the United States.

Association of a higher density of specialist neuroscience providers with fewer deaths from stroke in the United States population

“…1,13,29 Along the same lines, telemedicine and telestroke care is increasingly used to provide timely care in stroke patients. 8,9,28 Recent studies have demonstrated increased stroke-related mortality during the weekends, potentially due to the decreased availability of specialized care providers. 20,32 The "weekend effect" has been eliminated in comprehensive centers with around-the-clock availability of neurologists, neurosurgeons, and intensivists.…”

Effect of Telestroke on Emergent Stroke Care and Stroke Outcomes

“…A cost-effectiveness analysis was conducted to compare hub and spoke telestroke networks with usual care (remote emergency physicians without telestroke consultations). 41 Using a decision-analytic model, when compared with usual care, the telestroke networks provided an incremental cost-effectiveness ratio of $108 363/ quality-adjusted life year gain for a 90-day horizon and $2449/quality-adjusted life year gained for a lifetime horizon. The differences in results from the 2 time horizons illustrate the effect of the initial costs of establishing a stroke telemedicine service, which are balanced over the longer term by the reduced need for rehabilitation and advanced nursing care when there is increased use of tPA.…”

Telemedicine in Leading US Neurology Departments

“…22 Insurance coverage for telemedicine may expand substantially under this proposal, but this remains speculative given the financial pressures on federal and state governments and little research on the effectiveness of teleneurology in the United States, with the exception of telestroke. 23,24 Other funding sources for telemedicine programs in neurology include payment from sites, government grants, and funding from foundations or philanthropy. Some community hospitals or other originating sites receiving telemedicine (eg, prisons) experience reduced costs associated with patient transportation and staff time, as staff are often required to accompany patients on visits.…”