Cost-effectiveness of the Victorian Stroke Telemedicine program
Joosup Kim A B , Elise Tan C , Lan Gao C , Marj Moodie C , Helen M Dewey D , Kathleen L. Bagot A B , Nancy Pompeani B , Lauren Sheppard C , Christopher F. Bladin B D E and Dominique A. Cadilhac A B *A Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic., Australia.
B Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia.
C Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Vic., Australia.
D Eastern Health and Eastern Health Clinical School, Monash University, Box Hill, Vic., Australia.
E Ambulance Victoria, Melbourne, Vic., Australia.
Australian Health Review 46(3) 294-301 https://doi.org/10.1071/AH21377
Submitted: 14 February 2022 Accepted: 15 April 2022 Published: 20 May 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
Abstract
Objective Stroke telemedicine improves the provision of reperfusion therapies in regional hospitals, yet evidence of its cost-effectiveness using patient-level data is lacking. The aim of this study was to estimate the cost per quality-adjusted life year (QALY) gained from stroke telemedicine.
Methods As part of the Victorian Stroke Telemedicine (VST) program, stroke telemedicine provided to 16 hospitals in regional Victoria was evaluated using a historical-control design. Patient-level costs from a societal perspective (2018 Australian dollars (A$)) and QALYs up to 12 months after stroke were estimated using data from medical records, surveys at 3 months and 12 months after stroke and multiple imputation. Multivariable regression models and bootstrapping were used to estimate differences between periods.
Results Costs and health outcomes were estimated from 1024 confirmed strokes suffered by patients arriving at hospital within 4.5 h of stroke onset (median age 76 years, 55% male, 83% ischaemic stroke; 423 from the control period). Total costs to 12 months post stroke were estimated to be A$82 449 per person for the control period and A$82 259 in the intervention period (P = 0.986). QALYs at 12 months were estimated to be 0.43 per person for the control period and 0.5 per person in the intervention period (P = 0.02). Following 1000 iterations of bootstrapping, in comparison to the control period, the VST intervention was more effective and cost saving in 50.6% of iterations and cost-effective (A$0 and A$50 000 per QALY gained) in 10.4% of iterations.
Conclusion The VST program was likely to be cost saving or cost-effective. Our findings provide confidence in supporting wider implementation of telemedicine for acute stroke care in Australia.
Keywords: acute care, cerebrovascular disease, cost-effectiveness, costs, economic evaluation, emergency medicine, hospitals, stroke, telehealth.
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