Abstract 3077: Meta-analysis & Simulation Models For Cost Effectiveness and Sustainability of Telestroke
Introduction: Telestroke networks can readily address the challenges of stroke care in rural/isolated health care settings.
Method: A PubMed search for all studies on “Telestroke” networks was conducted. Only English language studies from the developed world were included. A meta-analysis comparing the cost savings offered by a Telestroke networks to traditional care models for treating acute ischemic stroke patients was performed. Revenue generation from Telestroke consultations was simulated and compared to reported costs of initiation of Telestroke networks to conduct a break-even probability analysis. A sensitivity analysis was done to investigate the robustness of this model to changing variable costs of Telestroke mediated care. All costs were in 2010 US$.
Results: A total of 15 Telestroke networks and 23,952 consultations were analyzed. Nearly 10.8% received IV-tPA therapy. From prior studies it was estimated that total cost savings per patient treated with IV rt-tPA was $6000 (1996 US$) after taking into account the increased hospitalization cost ($1,700 per patient), decreased average in-patient length of stay (1.5 days), decreased rehabilitation cost ($1400) and decreased nursing cost per patient ($4,800). Application of this cost saving to the Telestroke studies resulted into a total cost savings of $90,000 per 100 consultations. The average duration of consultation reported by these networks was 28.25 minutes (SD 18.86 minutes) generating average potential revenue of $48.7 per consultation as per Medicare reimbursement guidelines. The total approximate fixed costs of setup was $33,400/year/spoke site. Simulation analysis revealed that 283 patients per "spoke site" were needed to break-even upon investment costs of Telestroke, with just reimbursement of consultation costs accounting for revenue. After introducing uncertainties, the model generated a probability of 80.1% that the network would break-even on its costs within the first year of operation. Taking into account the increasing variable costs of operations and network maintenance, if the spoke-unit saw at least 283 patients annually, and if variable costs were kept below $35/patients, the Telestroke model would prove to be sustainable and cost effective.
Conclusion: Telestroke appears to be a cost effective strategy with a potentially sustainable business model in delivery of health care to ischemic stroke patients.
- © 2012 by American Heart Association, Inc.