Implementation and Evaluation of an Economic Model for Telestroke: Experience from Virtuall, France

Abstract

BackgroundTelestroke is recognized as a safe and time-efficient way of treating stroke patients. However, admission centers (spokes) are subject to financial charges which can make them reluctant to join the system. We implemented and assessed an economic model supporting our telestroke system, Virtuall, France, which includes one expert center (hub) and six spokes.MethodsThe model is based on payment for the expertise provided by the hub, distribution of charges related to telemedicine according to the fees perceived by the spokes, and transfer of patients between the spokes and the hub. We performed a cost–benefit analysis for all patients included in Virtuall from January 2014 to December 2015 to assess the economic balance in each center.Results321 patients were prospectively included in the study. Application of the economic model resulted in overall financial balance with funding of a dedicated medical service in the hub, and reduced costs directly related to telestroke by an average of 10% in the spokes. The conditions generating the highest costs for the spokes were: a patient returning from the hub for re-hospitalization (mean cost of $1,995/patient); management of patients treated by intravenous thrombolysis without transfer to the hub (mean cost of $2,075/patient). The most favorable financial condition for the spokes remained simple transfer of patients to the hub and no return (mean cost of $329/patient).ConclusionWe describe an economic model which can be applied to any telestroke system to ensure the optimal balance between hub and spoke centers.

Exploring Quantitative Methodologies for Assessing the Environmental, Social, and Economic Impacts of Telemedicine: A Literature Review

“…Specifically, within the socio-economic article cluster, two papers implemented costutility analyses [75,76], eight studies employed cost-effectiveness surveys [52,58,60,64,[77][78][79][80], eight conducted cost-benefit analyses [57,74,[81][82][83][84][85], and one utilized the classic cost accounting technique [56]. Cost-benefit analyses were also detected in articles included in the economic cluster [86][87][88][89][90][91][92][93]. In this case, costs and benefits were defined in monetary terms, including via the Net Present Value (NPV), Internal Rate of Return (IRR), and Quality of Service (QoS).…”

United States Medicolegal Progress and Innovation in Telemedicine in the Age of COVID-19: A Primer for Neurosurgeons

“…Analyses have repeatedly shown that clinical outcomes using telestroke are equal to in-person care and further reduce hospital and societal costs. [62][63][64][65] Telesurgery, or the use of robotics to perform hospital rounds and surgical procedures, is another emerging telemedicine component. 66,67 Currently, nearly 50% of the US population is more than an hour away from tertiary medical centers capable of providing adequate neurosurgical care, rehabilitation, and/or stroke management.…”