Cost analysis review of stroke centers, telestroke, and rt-PA

Objective: To conduct a systematic literature review analyzing cost-effectiveness or cost savings associated with use of recombinant tissue plasminogen activator (rt-PA), stroke centers, and telemedicine programs for acute ischemic stroke. Methods: A literature search was conducted of the PubMed/MEDLINE and Ovid/EMBASE databases from January 1, 1995, to August 30, 2008, limited to English-language articles and using the search terms [stroke and cost and telemedicine] or [stroke and cost and alteplase] or [stroke and cost and tissue plasminogen activator] or [stroke and cost and rt-PA] or [stroke center and cost] or [stroke unit and cost]. Abstracts were reviewed, and inclusion/exclusion criteria were used to select studies. The analysis was limited to studies addressing costs or cost-effectiveness of the interventions in the United States. Results: This search identified 748 abstracts, of which 24 were included. Among these 24 studies were 2 cost-effectiveness, 8 cost-savings, and 4 cost-benefit analyses. All discussed some aspect of practice economics. The primary cost-effectiveness data available for rt-PA use demonstrated increased hospitalization costs but long-term cost savings due to decreased nursing home and rehabilitation costs. No cost-effectiveness studies for stroke centers or telemedicine programs were identified, although stroke centers have been shown to reduce hospital length of stay and both stroke centers and telemedicine programs have demonstrated increased rates of rt-PA administration within 3 hours of the onset of stroke symptoms. Conclusion: More high-quality, current cost-effectiveness research for stroke centers, care networks, and telemedicine is needed to inform treatment decisions and resource utilization.