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Efficiency of telemedicine for acute stroke: a cost-effectiveness analysis from a French pilot study

Published online by Cambridge University Press:  02 March 2020

Laure Wallut Open the ORCID record for Laure Wallut [Opens in a new window] ,
Christine Peyron ,
Marie Hervieu-Bègue ,
Guy-Victor Osseby ,
Maurice Giroud ,
Nicolas Legris ,
Catherine Quantin ,
Yannick Béjot  and
Catherine Lejeune
Laure Wallut*
Affiliation:
Laboratoire d’Économie de Dijon, EA (7467), Université de Bourgogne-Franche-Comté, Pôle d'Economie et de Gestion, 2 bd Gabriel – BP 26 611, 21066Dijon cedex, France
Christine Peyron
Affiliation:
Laboratoire d’Économie de Dijon, EA (7467), Université de Bourgogne-Franche-Comté, Pôle d'Economie et de Gestion, 2 bd Gabriel – BP 26 611, 21066Dijon cedex, France
Marie Hervieu-Bègue
Affiliation:
Dijon Stroke Registry, EA7460, Dijon University Hospital, University of Burgundy and Medical School of Dijon, Dijon, France
Guy-Victor Osseby
Affiliation:
Dijon Stroke Registry, EA7460, Dijon University Hospital, University of Burgundy and Medical School of Dijon, Dijon, France
Maurice Giroud
Affiliation:
Dijon Stroke Registry, EA7460, Dijon University Hospital, University of Burgundy and Medical School of Dijon, Dijon, France
Nicolas Legris
Affiliation:
Dijon Stroke Registry, EA7460, Dijon University Hospital, University of Burgundy and Medical School of Dijon, Dijon, France
Catherine Quantin
Affiliation:
CHRU Dijon, Service de Biostatistiques et d'Information Médicale (DIM), Dijon, F-21000, France Univ. Bourgogne Franche-Comté, Dijon, F-21000, France Inserm CIC 1432, Clinical Epidemiology Unit, Dijon University Hospital, Dijon, France Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
Yannick Béjot
Affiliation:
Dijon Stroke Registry, EA7460, Dijon University Hospital, University of Burgundy and Medical School of Dijon, Dijon, France
Catherine Lejeune
Affiliation:
Inserm CIC 1432, Clinical Epidemiology Unit, Dijon University Hospital, Dijon, France
*
Author for correspondence: Laure Wallut, E-mail: [email protected]
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Abstract

Objectives

Telestroke is an effective way to improve care and health outcomes for stroke patients. This study evaluates the cost-effectiveness of a French telestroke network.

Methods

A decision analysis model was built using population-based data. We compared short-term clinical outcomes and costs for the management of acute ischemic stroke patients before and after the implementation of a telestroke network from the point of view of the national health insurance system. Three effectiveness endpoints were used: hospital death, death at 3 months, and severe disability 3 months after stroke (assessed with the modified Rankin scale). Most clinical and economic parameters were estimated from the medical files of 742 retrospectively included patients. Sensitivity analyses were performed.

Results

The analyses revealed that the telestroke strategy was more effective and slightly more costly than the reference strategy (25 disability cases avoided per 1,000 at 3 months, 6.7 avoided hospital deaths, and 13 avoided deaths at 3 months for an extra cost of EUR 97, EUR 138, and EUR 154, respectively). The results remained robust in the sensitivity analyses.

Conclusions

In France, telestroke is an effective strategy for improving patient outcomes and, despite the extra cost, it has a legitimate place in the national health care system.

Keywords

Cost-effectivenessdecision analysis modeltelemedicinestroke
Type
Assessment
Information
International Journal of Technology Assessment in Health Care , Volume 36 , Issue 2 , April 2020 , pp. 126 - 132
Copyright
Copyright © Cambridge University Press 2020

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References

GBD 2015 Mortality and Causes of Death Collaborators (2016) Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Lond Engl 388, 1459-1544.CrossRefGoogle Scholar
Béjot, Y, Bailly, H, Graber, M et al. (2019) Impact of the ageing population on the burden of stroke: the dijon stroke registry. Neuroepidemiology 52, 78-85.CrossRefGoogle ScholarPubMed
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333, 1581-1588.CrossRefGoogle Scholar
Langhorne, P, Williams, BO, Gilchrist, W, Howie, K(1993) Do stroke units save lives? Lancet Lond Engl 14, 395-398.CrossRefGoogle Scholar
Hacke, W, Kaste, M, Bluhmki, E et al. (2008) Thrombolysis with alteplase 3 to 4.5 h after acute ischemic stroke. N Engl J Med 359, 1317-1329.CrossRefGoogle Scholar
European Stroke Organisation (2008) Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovas Dis 25, 457-507.CrossRefGoogle Scholar
Leys, D, Ringelstein, EB, Kaste, M et al. (2007) Facilities available in European hospitals treating stroke patients. Stroke 38, 2985-2991.CrossRefGoogle ScholarPubMed
Silva, GS, Farrell, S, Shandra, E, Viswanathan, A, Schwamm, LH(2012) The status of telestroke in the United States: A survey of currently active stroke telemedicine programs. Stroke 43, 2078-2085.CrossRefGoogle ScholarPubMed
Levine, SR, Gorman, M (1999) 'Telestroke': the application of telemedicine for stroke. Stroke 30, 464-469.CrossRefGoogle Scholar
Johansson, T, Wild, C (2010) Telemedicine in acute stroke management: Systematic review. Int J Technol Assess Health Care 26, 149-155.CrossRefGoogle ScholarPubMed
Delpont, B, Blanc, C, Mariet, AS et al. (2017) Efficacité des filières dédiées à l'Accident Vasculaire Cérébral. Moyens de mesure. Expérience en Bourgogne. J Gest Econ Medicales 35, 18-31.Google Scholar
Walter, S, Kostopoulos, P, Haass, A et al. (2012) Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial. Lancet Neurol 11, 397-404.CrossRefGoogle Scholar
Legris, N, Hervieu-Bègue, M, Daubail, B et al. (2016) Telemedicine for the acute management of stroke in Burgundy, France: an evaluation of effectiveness and safety. Eur J Neurol 23, 1433-1440.CrossRefGoogle ScholarPubMed
Caro, JJ, Huybrechts, KF, Duchesne, I (2000) Management patterns and costs of acute ischemic stroke: An international study. For the Stroke Economic Analysis Group. Stroke 31, 582-590.CrossRefGoogle Scholar
Ehlers, L, Müskens, WM, Jensen, LG, Kjølby, M, Andersen, G (2008) National use of thrombolysis with alteplase for acute ischaemic stroke via telemedicine in Denmark: A model of budgetary impact and cost effectiveness. CNS Drugs 22, 73-81.CrossRefGoogle Scholar
Nelson, RE, Saltzman, GM, Skalabrin, EJ, Demaerschalk, BM, Majersik, JJ (2011) The cost-effectiveness of telestroke in the treatment of acute ischemic stroke. Neurology 77, 1590-1598.CrossRefGoogle ScholarPubMed
Switzer, JA, Demaerschalk, BM, Xie, J et al. (2013) Cost-effectiveness of hub-and-spoke telestroke networks for the management of acute ischemic stroke from the hospitals’ perspectives. Circ Cardiovasc Qual Outcomes 6, 18-26.CrossRefGoogle ScholarPubMed
Demaerschalk, BM, Switzer, JA, Xie, J et al. (2013) Cost utility of hub-and-spoke telestroke networks from societal perspective. Am J Manag Care 19, 976-985.Google ScholarPubMed
Nelson, RE, Okon, N, Lesko, AC et al. (2015) The cost-effectiveness of telestroke in the Pacific Northwest region of the USA. J Telemed Telecare 22, 413-421.CrossRefGoogle ScholarPubMed
Whetten, J, Goes (van der), DN, Tran, H et al. (2018) Cost-effectiveness of Access to Critical Cerebral Emergency Support Services (ACCESS): A neuro-emergent telemedicine consultation program. J Med Econ 21, 1-8.CrossRefGoogle ScholarPubMed
Drummond, MF, Sculpher, MJ, Claxton, K, Stoddart, GL, Torrance, GW (2015) Methods for the economic evaluation of health care programmes. 4th ed.Oxford: Oxford University Press.Google Scholar
Fagan, SC, Morgenstern, LB, Petitta, A et al. (1998) Cost-effectiveness of tissue plasminogen activator for acute ischemic stroke. NINDS rt-PA Stroke Study Group. Neurology 50, 883-890.CrossRefGoogle ScholarPubMed
Peyron, C, Wallut, L (2017) Tarification à l'activité et équilibre financier des prises en charge avec télémédecine: l'exemple du dispositif TéléAVC en Bourgogne, Financial balance of hospital care in a telestroke network: the case of the TéléAVC network in Burgundy. J Gest Déconomie Médicales 34, 415-429.CrossRefGoogle Scholar
Chevreul, K, Durand-Zaleski, I, Gouépo, A et al. (2013) Cost of stroke in France. Eur J Neurol 20, 1094-1100.CrossRefGoogle ScholarPubMed
Haute Autorité de Santé (2011) Choix méthodologiques pour l’évaluation économique à la HAS - guide méthodologique [Internet]. Available from: http://www.has-sante.fr/upload/docs/application/pdf/2011-11/guide_methodo_vf.pdf. Accessed 2019.Google Scholar
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