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

R. E. Nelson, G. M. Saltzman, E. J. Skalabrin, Bart M Demaerschalk, J. J. Majersik

Research output: Contribution to journalArticle

95 Citations (Scopus)

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 <$50,000/QALY, a ratio commonly considered acceptable in the United States. Conclusion: When a lifetime perspective is taken, telestroke appears cost-effective compared to usual care, since telestroke costs are upfront but benefits of improved stroke care are lifelong. If barriers to use such as low reimbursement rates and high equipment costs are reduced, telestroke has the potential to diminish the striking geographic disparities of acute stroke care in the United States.

Original languageEnglish (US)
Pages (from-to)1590-1598
Number of pages9
JournalNeurology
Volume77
Issue number17
DOIs
StatePublished - Oct 25 2011

Fingerprint

Quality-Adjusted Life Years
Cost-Benefit Analysis
Stroke
Costs and Cost Analysis
Hospital Emergency Service
Therapeutics
Referral and Consultation
Cost-effectiveness
Costs
Technology
Physicians
Equipment and Supplies

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

The cost-effectiveness of telestroke in the treatment of acute ischemic stroke. / Nelson, R. E.; Saltzman, G. M.; Skalabrin, E. J.; Demaerschalk, Bart M; Majersik, J. J.

In: Neurology, Vol. 77, No. 17, 25.10.2011, p. 1590-1598.

Research output: Contribution to journalArticle

Nelson, R. E. ; Saltzman, G. M. ; Skalabrin, E. J. ; Demaerschalk, Bart M ; Majersik, J. J. / The cost-effectiveness of telestroke in the treatment of acute ischemic stroke. In: Neurology. 2011 ; Vol. 77, No. 17. pp. 1590-1598.
@article{a56f5e2600ee43b380db3ddeec91fa85,
title = "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 <$50,000/QALY, a ratio commonly considered acceptable in the United States. Conclusion: When a lifetime perspective is taken, telestroke appears cost-effective compared to usual care, since telestroke costs are upfront but benefits of improved stroke care are lifelong. If barriers to use such as low reimbursement rates and high equipment costs are reduced, telestroke has the potential to diminish the striking geographic disparities of acute stroke care in the United States.",
author = "Nelson, {R. E.} and Saltzman, {G. M.} and Skalabrin, {E. J.} and Demaerschalk, {Bart M} and Majersik, {J. J.}",
year = "2011",
month = "10",
day = "25",
doi = "10.1212/WNL.0b013e318234332d",
language = "English (US)",
volume = "77",
pages = "1590--1598",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "17",

}

TY - JOUR

T1 - The cost-effectiveness of telestroke in the treatment of acute ischemic stroke

AU - Nelson, R. E.

AU - Saltzman, G. M.

AU - Skalabrin, E. J.

AU - Demaerschalk, Bart M

AU - Majersik, J. J.

PY - 2011/10/25

Y1 - 2011/10/25

N2 - 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 <$50,000/QALY, a ratio commonly considered acceptable in the United States. Conclusion: When a lifetime perspective is taken, telestroke appears cost-effective compared to usual care, since telestroke costs are upfront but benefits of improved stroke care are lifelong. If barriers to use such as low reimbursement rates and high equipment costs are reduced, telestroke has the potential to diminish the striking geographic disparities of acute stroke care in the United States.

AB - 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 <$50,000/QALY, a ratio commonly considered acceptable in the United States. Conclusion: When a lifetime perspective is taken, telestroke appears cost-effective compared to usual care, since telestroke costs are upfront but benefits of improved stroke care are lifelong. If barriers to use such as low reimbursement rates and high equipment costs are reduced, telestroke has the potential to diminish the striking geographic disparities of acute stroke care in the United States.

UR - http://www.scopus.com/inward/record.url?scp=82955167978&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=82955167978&partnerID=8YFLogxK

U2 - 10.1212/WNL.0b013e318234332d

DO - 10.1212/WNL.0b013e318234332d

M3 - Article

C2 - 21917781

AN - SCOPUS:82955167978

VL - 77

SP - 1590

EP - 1598

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 17

ER -