title: Cost utility of hub-and-spoke telestroke networks from societal perspective.
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.
  
  
  OBJECTIVE
  To evaluate the cost utility of a telestroke network in the management of acute ischemic stroke from the societal perspective.
  
  
  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.
authors: Divisions of Vascular, Hospital, and Critical Care Neurology, Department of Neurology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054. E-mail: demaerschalk.bart@mayo.edu.
authors: Bart M
authors: BM
authors: Demaerschalk
authors: Jeffrey A
authors: JA
authors: Switzer
authors: Jipan
authors: J
authors: Xie
authors: Liangyi
authors: L
authors: Fan
authors: Kathleen F
authors: KF
authors: Villa
authors: Eric Q
authors: EQ
authors: Wu
mesh_terms: D003362:Cost-Benefit Analysis; D005845:Georgia; D006780:Hospitals, Rural / Q000191:economics; D006801:Humans; D008390:Markov Chains; D008910:Minnesota; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000191:economics / Q000628:therapy*; D017216:Telemedicine / Q000191:economics*