Cost-utility tele-stroke in adults with acute ischemic stroke. A systematic review

Tele-Stroke has been proposed as a solution to increase access to thrombolytic therapy in acute ischemic stroke. Objective: Synthesise the evidence of the cost-effectiveness of Tele-Stroke. Study Design: Systematic Literature Review.

Systematic review of cost-effectiveness economic evaluations of Tele-Stroke from the Centre for Reviews and Dissemination of the University of York, International HTA Database, PubMed, EMBASE, Cochrane Library, Cost-Effectiveness Analysis Registry, National Institute for Health and Care Excellence, The European Network of Health Economic Evaluation Databases Project and grey literature. Quality assessment, data selection and data extraction were performed by two reviewers. A qualitative synthesis was conducted.

Twelve studies, published between 2008 and 2022 in high-income countries were included; 50.00 % were conducted from a health system perspective and the most frequent discount rate was 3 %. Spoke/Hub ratio ranged from 1:1 to 17:2. In 5/12 studies Tele-Stroke was found to be highly cost-effective (dominant intervention: lower cost and higher effectiveness) and only two acceptable (lower cost and lower effectiveness). Incremental Cost Effectiveness Ratio (ICER) per Quality-Adjusted Life Years (QALY) gained ranged from US$ 290,368.77 to US$ 327.44 in 2022. Conclusions: Most of the studies showed that the Tele-Stroke programme could be a cost-effective strategy, both from a social and health system perspective; however, most of the studies were from middle-and-high-income countries, which requires analysis before implementation in low-income countries.