title: Making the call: is telestroke cost effective?
abstract: The clinical efficacy of intravenous tissue plasminogen activator (tPA) in acute ischemic stroke is proven, and the cost-efficacy of tPA is realized through reduction in disability and associated long-term care. Only a modest proportion of eligible stroke patients receive tPA. Potential barriers include distance from treatment centers and lack of local expertise and infrastructure. Nelson and colleagues describe a telecommunications strategy to facilitate increased delivery of thrombolysis. The analysis used a model based on an expert stroke-center 'hub' offering video-based liaison with several peripheral hospital 'spokes'. Economic modeling suggested cost efficacy of this approach, albeit with all the caveats that come with long-term economic analyses of an acute stroke intervention. There is a clinical, ethical and economical imperative to increase uptake of evidence-based acute stroke therapies. These encouraging data suggest that use of audiovisual technologies may facilitate greater access to thrombolysis.
authors.affiliation: Institute of Cardiovascular and Medical Sciences, School of Medicine, University of Glasgow, Walton Building, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK. patricia.fearon@glasgow.ac.uk
authors.forename: P
authors.initials: P
authors.lastname: Fearon
authors.forename: T J
authors.initials: TJ
authors.lastname: Quinn