Quantifying the cost savings of the South Australian Telestroke Service

BackgroundFew studies have explored the cost and clinical impacts of enhanced telehealth interventions for stroke in contemporaneous practice. As such, we sought to compare the cost-effectiveness of a clinical service supported by a purpose built platform for stroke telehealth in South Australia.MethodsMarkov decision analytic models were constructed to model the implementation of an enhanced telehealth programme versus historical controls with limited referral support. The models were profiled on a minimum dataset of 470 patients with stroke symptoms presenting across eight regional/rural hospitals in South Australia. Clinical outcomes and costs were derived from published sources. Incremental cost-effectiveness ratios were used to estimate the cost-effectiveness of the telehealth platform over a lifetime time horizon, from the perspective of the Australian healthcare system compared with a historical control.ResultsImplementation of the South Australia Telestroke programme was associated with a gain of 0.10 quality-adjusted life years and a cost saving of $3873 per patient. That is, over a 5-year period, the introduction of technology-enabled telehealth resulted in a total projected cost saving of $8.7 million (M). This was driven by a reduction in the costs attributed to management (per patient -$2676; total projected: -$6.0 M), nursing home care (per patient: -$3268; total projected: -$7.3 M), non-medical costs (per patient: -$510; total projected: -$1.1 M) and futile transfers (per patient: -$111; total projected: -$250,248), which offset higher intervention costs (per patient: $2674; total projected: $6.0 M) and hospital costs (per patient: $18; total projected: $41,092). Sensitivity analyses confirmed the robustness of these findings.ConclusionThe implementation of an enhanced telehealth programme improves patient outcomes and is cost-saving relative to a telestroke programme with limited referral support. Our findings support ongoing implementation of the enhanced telehealth programme across South Australian hospitals.