title: The cost-effectiveness of telestroke in the Pacific Northwest region of the USA.
abstract: BACKGROUND
  Using real-world data from the Providence Oregon Telestroke Network, we examined the cost-effectiveness of telestroke from both the spoke and hub perspectives by level of financial responsibility for these costs and by patient stroke severity.
  
  
  METHODS
  We constructed a decision analytic model using patient-level clinical and financial data from before and after telestroke implementation. Effectiveness was measured as quality-adjusted life years (QALYs) and was combined with cost per patient outcomes to calculate incremental cost effectiveness ratios (ICERs). Outcomes were generated (a) overall; (b) by stroke severity, via the National Institute of Health Stroke Scale (NIHSS) at time of arrival, defined as low (<5), medium (5-14) and high (>15); and (c) by percentage of implementation costs paid by spokes (0%, 50%, 100%).
  
  
  RESULTS
  Data for 864 patients, 98 pre- and 766 post-implementation, were used to parameterize our model. From the spoke perspective, telestroke had ICERs of US$1322/QALY, US$25,991/QALY and US$50,687/QALY when responsible for 0%, 50%, and 100% of these costs, respectively. Overall, the ICER ranged from US$22,363/QALY to US$71,703/QALY from the hub perspective.
  
  
  CONCLUSIONS
  Our results support previous models showing good value, overall. However, costs and ICERs varied by stroke severity, with telestroke being most cost-effective for severe strokes. Telestroke was least cost effective for the spokes if spokes paid for more than half of implementation costs.
authors.affiliation: Veterans Affairs Salt Lake City Health Care System, USA Department of Internal Medicine, University of Utah School of Medicine, USA richard.nelson@utah.edu.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Nelson
authors.affiliation: Northwest Stroke Solutions, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Okon
authors.affiliation: Providence Brain and Spine Institute, USA.
authors.forename: Alexandra C
authors.initials: AC
authors.lastname: Lesko
authors.affiliation: Department of Neurology, University of Utah School of Medicine, USA.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Majersik
authors.affiliation: Providence Brain and Spine Institute, USA.
authors.forename: Archit
authors.initials: A
authors.lastname: Bhatt
authors.affiliation: Providence Brain and Spine Institute, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Baraban
mesh_terms: D000203:Activities of Daily Living; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D017048:Health Care Costs; D006801:Humans; D018803:Models, Economic; D015205:Northwestern United States; D016730:Program Development / Q000191:economics / Q000379:methods; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D020521:Stroke / Q000191:economics / Q000628:therapy*; D017216:Telemedicine / Q000191:economics* / Q000379:methods / Q000458:organization & administration; D016896:Treatment Outcome
keywords: Cost-effectiveness analysis; stroke; telestroke