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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: laure.wallut@u-bourgogne.fr
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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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