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Efficiency of telemedicine for acute stroke: a cost-effectiveness analysis from a French pilot study
Laure Wallut1, Christine Peyron1, Marie Hervieu-Bègue2
1Laboratoire d'Économie de Dijon, EA (7467), Université de Bourgogne-Franche-Comté, Pôle d'Economie et de Gestion, 2 bd Gabriel - BP 26 611, 21066Dijon cedex, France.
Objectives:
Telestroke is an effective way to improve care and health outcomes for stroke patients. This study evaluates the cost-effectiveness of a French telestroke network.
Methods:
A decision analysis model was built using population-based data. We compared short-term clinical outcomes and costs for the management of acute ischemic stroke patients before and after the implementation of a telestroke network from the point of view of the national health insurance system. Three effectiveness endpoints were used: hospital death, death at 3 months, and severe disability 3 months after stroke (assessed with the modified Rankin scale). Most clinical and economic parameters were estimated from the medical files of 742 retrospectively included patients. Sensitivity analyses were performed.
Results:
The analyses revealed that the telestroke strategy was more effective and slightly more costly than the reference strategy (25 disability cases avoided per 1,000 at 3 months, 6.7 avoided hospital deaths, and 13 avoided deaths at 3 months for an extra cost of EUR 97, EUR 138, and EUR 154, respectively). The results remained robust in the sensitivity analyses.
Conclusions:
In France, telestroke is an effective strategy for improving patient outcomes and, despite the extra cost, it has a legitimate place in the national health care system.
