Medico-economic modelling of stroke care with telemedicine. An experience in Franche-Comté

Goff-Pronost, Myriam Le; Bouamra, Benjamin; Gantzer, Stéphane; Moulin, Thierry

doi:10.1016/j.eurtel.2017.07.001

Cited by 6 publications

(11 citation statements)

References 12 publications

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“…The included studies comprised two cost-effectiveness and six cost–utility analyses investigating the use of telemedicine network(s) in the USA (five), France (two) and Denmark (one). All studies entailed the development of a model to estimate the costs and effectiveness of telestroke, with five 20,47,48,49,50 mainly relying on inputs sourced from the literature, whilst the other three 19,25,51 used within-trial data and model-based extrapolation analyses. The perspective ranged from individual hospitals 25,47,48 to a broader societal context.…”

Section: Resultsmentioning

confidence: 99%

“…20,49 Of the eight studies, five reported telestroke as costeffective (included four as cost-saving), 19,20,47,49,50 two were potentially cost-effective 25,51 and one did not report results clearly. 48 For studies that compared cost-effectiveness across various time horizons, the cost-effectiveness of telestroke consistently improved over a longer period of time. 20,49,50 Source: Whetten et al, 19 Demaerschalk et al, 20 Nelson et al, 25 Switzer et al, 47 Le Goff-Pronost et al, 48 Nelson et al, 49 Ehlers et al, 50 Wallut et al2020 51 AIS: acute ischaemic stroke; ED: emergency department; CUA: cost-utility analysis; CEA: cost-effectiveness analysis; US$: United States Dollar; QALY: quality-adjusted life year; ICER: incremental cost-effectiveness ratio; CHEERS: consolidated health economic evaluation reporting standards; QHES: quality of health economic studies; POTN: Providence Oregon Telestroke Network; ACCESS: Access to Critical Cerebral Emergency Support Services.…”

Section: Systematic Reviewmentioning

confidence: 99%

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Telestroke for acute ischaemic stroke: A systematic review of economic evaluations and a de novo cost–utility analysis for a middle income country

et al. 2021

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Introduction Telemedicine can alleviate the problems faced in rural settings in providing access to specialist stroke care. The evidence of the cost-effectiveness of this model of care outside high-income countries is limited. This study aimed to conduct: (a) a systematic review of economic evaluations of telestroke and (b) a cost–utility analysis of telestroke, using China as a case study. Methods We systematically searched Embase, Medline Complete and Cochrane databases. Inclusion criteria: full economic evaluations of telemedicine/telestroke networks examining the use of thrombolysis in patients with acute ischaemic stroke, published in English. A cost–utility analysis was undertaken using a Markov model incorporating a decision tree to simulate the delivery of telestroke for acute ischaemic stroke in rural China, compared to no telestroke from a societal and healthcare perspective. One-way deterministic sensitivity analyses and probabilistic sensitivity analyses were performed to test the robustness of results. Results Of 559 publications found, eight met the eligibility criteria and were included in the systematic review (two cost-effectiveness analyses and six cost–utility analyses, all performed in high-income countries). Telestroke was a cost-saving/cost-effective intervention in five out of the eight studies. In our modelled analysis for rural China, telestroke was the dominant strategy, with estimated cost savings of Chinese yuan 4,328 (US$627) and additional 0.0925 quality-adjusted life years per patient. Sensitivity analyses confirmed the base case results. Discussion Consistent with published economic evaluations of telestroke in other jurisdictions, telestroke represents a cost-effective solution to enhance stroke care in rural China.

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Section: Resultsmentioning

confidence: 99%

Section: Systematic Reviewmentioning

confidence: 99%

Telestroke for acute ischaemic stroke: A systematic review of economic evaluations and a de novo cost–utility analysis for a middle income country

et al. 2021

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“…The difference of costs was estimated by taking into account the new additional cost generated by the implementation of the intensive follow-up for the 2 years of the experimentation and could be considered for both diseases (stroke/TIA and MI). The differential of 0.05 QALYs was conservative in view of the few values provided in the literature, for both stroke/TIA,24 37 and MI 27 38…”

Section: Methodsmentioning

confidence: 99%

“…Cost-utility analysis at 24 months The choice of the cost-utility analysis (CUA) in a primary objective is justified because of the importance of the quality of life after a stroke/TIA, [23][24][25][26] or a MI. 27 For each of the two diseases, an incremental cost-utility ratio at 24 months associated with the intensive follow-up when compared with the usual follow-up will be estimated and expressed in terms of cost per quality-adjusted life year (cost/QALY) gained.…”

Section: Medico-economic Outcomes Measurementioning

confidence: 99%

Efficiency and effectiveness of intensive multidisciplinary follow-up of patients with stroke/TIA or myocardial infarction compared to usual monitoring: protocol of a pragmatic randomised clinical trial. DiVa (Dijon vascular) study

Béjot

Soilly²,

Bardou

et al. 2023

BMJ Open

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IntroductionThe ongoing ageing population is associated with an increase in the number of patients suffering a stroke, transient ischaemic attack (TIA) or myocardial infarction (MI). In these patients, implementing secondary prevention is a critical challenge and new strategies need to be developed to close the gap between clinical practice and evidence-based recommendations. We describe the protocol of a randomised clinical trial that aims to evaluate the efficiency and effectiveness of an intensive multidisciplinary follow-up of patients compared with standard care.Methods and analysisThe DiVa study is a randomised, prospective, controlled, multicentre trial including patients >18 years old with a first or recurrent stroke (ischaemic or haemorrhagic) or TIA, or a type I or II MI, managed in one of the participating hospitals of the study area, with a survival expectancy >12 months. Patients will be randomised with an allocation ratio of 1:1 in two parallel groups: one group assigned to a multidisciplinary, nurse-based and pharmacist-based 2-year follow-up in association with general practitioners, neurologists and cardiologists versus one group with usual follow-up. In each group for each disease (stroke/TIA or MI), 430 patients will be enrolled (total of 1720 patients) over 3 years. The primary outcome will be the incremental cost–utility ratio at 24 months between intensive and standard follow-up in a society perspective. Secondary outcomes will include the incremental cost–utility ratio at 6 and 12 months, the incremental cost-effectiveness ratio at 24 months, reduction at 6, 12 and 24 months of the rates of death, unscheduled rehospitalisation and iatrogenic complications, changes in quality of life, net budgetary impact at 5 years of the intensive follow-up on the national health insurance perspective and analysis of factors having positive or negative effects on the implementation of the project in the study area.Ethics and disseminationEthical approval was obtained and all patients receive information about the study and give their consent to participate before randomisation. Results of the main trial and each of the secondary analyses will be submitted for publication in a peer-reviewed journal.Trial registration numberClinicalTrials.gov Identifier:NCT04188457. Registered on 6 December 2019.

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“…Cinq paramètres permettent d'évaluer le service rendu aux patients avec le taux de guérison, le taux de handicap et le taux de décès à 3 mois, le taux de complications hémorragiques, le taux d'accès à une reperfusion par thrombolyse ou thrombectomie, et le taux de prise en charge en USINV ou recours à l'expertise neurovasculaire [81][82][83]. Les aspects médico-économiques sont encore en cours d'évaluation [84][85][86][87][88][89]. Par exemple, l'expérimentation de type MSU a montré aussi son bénéfice avec un rapport coûtefficacité supplémentaire de 32 456 € par QALY [87,89].…”

Section: Quelques Aspects Juridiques Et D'évaluation Du Télé-avcunclassified

Télémédecine et accident vasculaire cérébral : « Rôle de la télémédecine dans les accidents vasculaires cérébraux »

Bustos

Ohannessian

Bouamra

et al. 2020

Bulletin de l'Académie Nationale de Médecine

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Medico-economic modelling of stroke care with telemedicine. An experience in Franche-Comté

Cited by 6 publications

References 12 publications

Telestroke for acute ischaemic stroke: A systematic review of economic evaluations and a de novo cost–utility analysis for a middle income country

Telestroke for acute ischaemic stroke: A systematic review of economic evaluations and a de novo cost–utility analysis for a middle income country

Efficiency and effectiveness of intensive multidisciplinary follow-up of patients with stroke/TIA or myocardial infarction compared to usual monitoring: protocol of a pragmatic randomised clinical trial. DiVa (Dijon vascular) study

Télémédecine et accident vasculaire cérébral : « Rôle de la télémédecine dans les accidents vasculaires cérébraux »

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