Cost utility of hub-and-spoke telestroke networks from societal perspective

Bart M. Demaerschalk, Jeffrey A. Switzer, Jipan Xie, Liangyi Fan, Kathleen F. Villa, Eric Q. Wu

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

BACKGROUND: A hub-and-spoke telestroke network is an effective way to extend quality emergency stroke care to remote hospitals and improve patient outcomes.

OBJECTIVES: To evaluate the cost utility of a telestroke network in the management of acute ischemic stroke from the societal perspective.

STUDY DESIGN AND METHODS: A lifetime Markov model was developed to compare the incremental costs and effectiveness of a telestroke network. One-year transition probabilities between the 3 health states based on the modified Rankin scale--minimal-to-no disability, moderate-to-severe disability, and death--were derived from literature. Costs included telemedicine setup and maintenance, initial and recurrent stroke treatment, rehabilitation, long-term care, and caregiver costs. Effectiveness was defined as quality-adjusted life-years (QALYs). Model inputs were obtained from the literature supplemented by data from Georgia Health Sciences University and Mayo Clinic. The base case network included 1 hub and 7 spokes, and assumed no survival benefits from acute treatment in a network. One-way sensitivity analyses were conducted.

RESULTS: Compared with no network, patients treated in a telestroke network incurred $1436 lower costs and gained 0.02 QALYs over a lifetime. Incremental costs decreased from $444 for the first year to -$1436 over a lifetime; incremental QALYs increased from 0.002 for the first year to 0.02 over a lifetime. Overall, results were robust in the 1-way sensitivity analyses. A telestroke network became less cost-effective with increasing spoke-to-hub transfer rates.

CONCLUSIONS: A telestroke network is cost savingand more effective compared with no network from the societal perspective in most modeled scenarios.

Original languageEnglish (US)
Pages (from-to)976-985
Number of pages10
JournalThe American journal of managed care
Volume19
Issue number12
Publication statusPublished - Dec 1 2013
Externally publishedYes

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ASJC Scopus subject areas

  • Health Policy

Cite this

Demaerschalk, B. M., Switzer, J. A., Xie, J., Fan, L., Villa, K. F., & Wu, E. Q. (2013). Cost utility of hub-and-spoke telestroke networks from societal perspective. The American journal of managed care, 19(12), 976-985.