Abstract 3152: Telemedicine is Cost Effective in Acute Ischemic Stroke
Introduction: Rapid availability to stroke specialists remains a critical hurdle in thrombolysis for acute ischemic stroke in many regions of the United States. Remote consultation is often utilized with varying success. Telemedicine use has been increasing but it is unclear if this is cost effective when compared to simple telephone consultation.
Hypothesis: We assessed the hypothesis that telemedicine is cost effective for acute ischemic stroke patients.
Methods: We created a decision tree model to compare telemedicine (with videoconferencing and image sharing) to telephone consultation. We estimated probabilities and utilities from the available literature and calculated incremental cost-effectiveness ratios (ICER). We used actual costs of telemedicine equipment, installation, and physician fees based on our own experience ($50,900 per hospital per year). We assumed equal access to standard medical treatments between the two approaches; an 8-hospital spoke system; and 60 patients assessed for acute stroke per year at each spoke hospital. However, we estimated higher tissue plasminogen activator (tPA) utilization among telemedicine-treated patients (28% vs 23%) based on the STRokE-DOC trial. We performed sensitivity analyses to assess all assumptions in our model. An ICER < $50,000/QALY was considered cost-effective.
Results: In the first year after stroke, telemedicine resulted in a gain of 0.00459 QALY, but with an additional cost of $799 compared to telephone only (ICER = $174,074/QALY). In the long term (over 30 years), telemedicine resulted in a gain of 0.0282 QALY at an additional cost of $497 (ICER = $17,624/QALY). Using a long term sensitivity analysis, ICER remained < $50,000/QALY when the absolute difference in tPA utilization (telemedicine vs. telephone) was > 2.5%. When the absolute difference in tPA use is > 12%, telemedicine had cost-saving effects (ICER < 0). Cost-effectiveness was also sensitive to number of patients: 30 or more patients must be evaluated with telemedicine per hospital annually to remain cost-effective. Telemedicine remained cost-effective when varying its program costs from $500 to $1,500 per patient.
Conclusions: Assuming that telemedicine consultations increase the use of tPA for acute ischemic stroke patients by at least 2.5%, we found that it is cost-effective compared to telephone only consultations. However, 30 patients must be assessed annually per spoke hospital to remain cost-effective. Telemedicine stroke networks need to consider these aspects when assessing their societal impact and when justifying their considerable costs.
- © 2012 by American Heart Association, Inc.