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, B. M.
AU - Majersik, J. J.
N1 - Funding Information:
Study funding: Supported in part by the NIH (NCI 1 KM1CA156723 and 5TL1RR025762–03 [J.J.M., R.E.N.]).
Funding Information:
Dr. Nelson receives research support from AHRQ, the NIH/NCI, and the US Veterans Administration (Office of Rural Health and HSR&D). Dr. Saltzman has received funding for travel and speaker honoraria from the National Education Association. Dr. Skalabrin reports no disclosures. Dr. Demaerschalk serves on the editorial boards of Stroke, Journal of Stroke and Cerebrovascular Diseases, Hospital Practice, and Open Critical Care Medicine Journal, and as Section Editor for The Neurologist; and receives/has received research support from AGA Medical Corporation, Vernalis plc, Mitsubishi Tanabe Pharma Corporation, Abbott, Penumbra, Inc., Axio Research, Neuralieve Inc., Genentech, Inc., the Arizona Department of Health Services, the National Stroke Association, and the NIH/NINDS. Dr. Majersik receives research support from the NIH/NCI; and has provided expert testimony in a medico-legal case.
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
SN - 0028-3878
VL - 77
SP - 1590
EP - 1598
JO - Neurology
JF - Neurology
IS - 17
ER -