The cost-effectiveness of telestroke in the Pacific Northwest region of the USA

J Telemed Telecare. 2016 Oct;22(7):413-21. doi: 10.1177/1357633X15613920. Epub 2015 Nov 4.


Introduction: Using real-world data from the Providence Oregon Telestroke Network, we examined the cost-effectiveness of telestroke from both the spoke and hub perspectives by level of financial responsibility for these costs and by patient stroke severity.

Methods: We constructed a decision analytic model using patient-level clinical and financial data from before and after telestroke implementation. Effectiveness was measured as quality-adjusted life years (QALYs) and was combined with cost per patient outcomes to calculate incremental cost effectiveness ratios (ICERs). Outcomes were generated (a) overall; (b) by stroke severity, via the National Institute of Health Stroke Scale (NIHSS) at time of arrival, defined as low (<5), medium (5-14) and high (>15); and (c) by percentage of implementation costs paid by spokes (0%, 50%, 100%).

Results: Data for 864 patients, 98 pre- and 766 post-implementation, were used to parameterize our model. From the spoke perspective, telestroke had ICERs of US$1322/QALY, US$25,991/QALY and US$50,687/QALY when responsible for 0%, 50%, and 100% of these costs, respectively. Overall, the ICER ranged from US$22,363/QALY to US$71,703/QALY from the hub perspective.

Conclusions: Our results support previous models showing good value, overall. However, costs and ICERs varied by stroke severity, with telestroke being most cost-effective for severe strokes. Telestroke was least cost effective for the spokes if spokes paid for more than half of implementation costs.

Keywords: Cost-effectiveness analysis; stroke; telestroke.

MeSH terms

  • Activities of Daily Living
  • Cost-Benefit Analysis
  • Decision Trees
  • Health Care Costs
  • Humans
  • Models, Economic
  • Northwestern United States
  • Program Development / economics
  • Program Development / methods
  • Quality-Adjusted Life Years
  • Severity of Illness Index
  • Stroke / economics
  • Stroke / therapy*
  • Telemedicine / economics*
  • Telemedicine / methods
  • Telemedicine / organization & administration
  • Treatment Outcome