In this first-of-its-kind U.S. health economic analysis, researchers have found that using two way audio-video telemedicine to deliver stroke care, also known as telestroke, appears to be cost-effective for rural hospitals that don’t have an around-the-clock neurologist, or stroke expert, on staff. The research is published in the September 14, 2011, online issue of Neurology®, the medical journal of the American Academy of Neurology.
In telestroke care, the use of a telestroke robot lets a stroke patient be seen in real time by a neurology specialist elsewhere who consults with an emergency room physician in the rural site via computer.
For the study, researchers used existing data from previous telestroke studies, as well as data from large multi-hospital telestroke network databases at Mayo Clinic in Phoenix and the University of Utah Health System in Salt Lake City. They calculated the cost-effectiveness of telestroke by comparing the incremental costs and quality-adjusted life years saved of stroke patients treated by telestroke to those treated by usual care such as a rural emergency department without telestroke or a stroke expert available. The Quality-adjusted life year is a measure of disease burden, including both the quality and the quantity of life lived. It is regularly used in assessing the value for money of a medical intervention.
“Cost-effectiveness analyses reveal to us how much health bang we get for our buck. We can assess medical services, like telemedicine, in terms of the net costs to society for each year of life gained,” said Bart Demaerschalk, M.D., professor of Neurology, director of Mayo Clinic Telestroke Program, and co-author of the telestroke cost effectiveness study.
The study found that the incremental cost effectiveness ratio for telestroke over a person’s lifetime was less than $2,500 per quality-adjusted life year. The threshold of $50,000 to $100,000 per quality-adjusted life year in the U.S. is commonly cited as the cut-off for cost-effectiveness.
“If the costs associated with the technology are reduced or if reimbursement opportunities increase we will recognize that this treatment modality may, in fact, save money,” Dr. Demaerschalk said. “The upfront costs associated with setting up the telestroke technology and managing the network organization are quickly offset by the financial gains that result from a higher proportion of patients receive clot busting drugs and the reduced stroke-related disability and subsequent reduced need for rehabilitation, nursing home care and assistance at home.”
“In an era of spiraling health care costs, our findings give critical information to medical policy makers,” said Jennifer J. Majersik, M.D., M.S., with the University of Utah School of Medicine in Salt Lake City and a member of the American Academy of Neurology. “Telestroke has the potential to greatly diminish the striking disparity in stroke care for rural America.”
In addition, researchers say telestroke can help with increasing the low number of stroke patients in rural areas receiving tissue plasminogen activator (tPA), the clot-busting drug that can reduce disability from stroke but must be given within the first three to 4.5 hours after symptoms begin.
Dr. Demaerschalk said this is critical in a state like Arizona with a large rural population.
“Only two to four percent of stroke patients receive this treatment, with the lowest percentage in rural areas largely because there aren’t enough stroke experts with experience using tPA,” said Dr. Majersik. “Telestroke has the potential to lower this barrier by providing long-distance consultation to rural areas, increasing the expertise and quality of stroke care at rural hospitals.”
The study was supported by the National Institutes of Health and the National Cancer Institute and was conducted by researchers at Mayo Clinic, the University of Utah, the University of Michigan and Albion College.
Mayo Clinic first used telemedicine technology with the stroke telemedicine program in 2007, when statistics revealed that 40 percent of residents in Arizona did not live in an area where they were availed of stroke expertise. Mayo Clinic was the first medical center in Arizona to do pioneering clinical research to study telemedicine as a means of serving patients with stroke in non-urban settings, and today serves as the “hub” in a network of 10 “spoke” centers. Since the stroke program began more than 700 emergency consultations for stroke between Mayo stroke neurologists and physicians at the spoke centers in Arizona have taken place. Beyond Arizona, Mayo Clinic Telestroke is represented nationally, with hub and spoke networks already in existence in Florida and in a development phase in Minnesota and Mayo Clinic Health System.