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RESEARCH PRODUCT

Telemedicine: Economic and clinical evaluation of the management of ischemic stroke

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Summary Introduction Ischemic stroke (IS) is a therapeutic emergency that requires prompt care in a stroke unit (SU). In order to reduce regional inequalities and to promote uniformity in access to this technique, which is effective when carried out quickly, telemedicine-assisted thrombolysis was developed in Burgundy within the Telestroke system. At the moment, no study compared costs (i.e. expenditures) and revenues (i.e. funding) associated with the management of patients presenting an IS in Burgundy after the implementation of the Telestroke system according to the management strategy: patients undergoing thrombolysis directly in a SU or Tele-thrombolysis in a local hospital (LH) receiving telemedicine assistance from SU followed by transfer to the SU. Patients and method All consecutive patients with acute IS confirmed by cerebral imaging who were treated with intravenous thrombolysis either at the SU or at a LH through a telemedicine procedure were included in this retrospective multicenter observational study between the 1st October 2012 and the 31st October 2013. Hospital costs and revenues were then collected and compared. The economic analysis was performed from the point of view of the healthcare centers (SU and LH). The secondary objectives were to compare the respect of the guidelines for the good use of r-TPA (alteplase), its clinical efficacy and tolerance according to the management strategy. Results Among the 92 patients included between the 1st October 2012 and the 31st October 2013, a total of 78 patients underwent direct thrombolysis in a SU and 14 thrombolysis in a LH with telemedicine assistance. A significant difference was found between the global cost per patient of according to the type of management: €13,998 ± €4155 for thrombolysis with telemedicine assistance in LH versus €11,645 ± €9778 for direct thrombolysis at the SU; P  = 0.13. With Tele-thrombolysis, no significant difference was found between costs per patient and total revenue per patient (€13,998 versus €13,436; P  = 0.46). With direct thrombolysis, costs per patient estimated was significantly greater than the revenue per patient (€11,645 versus €7095; P −3 ). From a clinical point of view, there was no significant difference between the thrombolysis at the LH with telemedicine assistance group and the direct thrombolysis at the SU group concerning the effectiveness and tolerance to r-TPA. Discussion and conclusion To be implemented and funded at a large scale, the clinical and budgetary impact of telemedicine need to be assessed. In our study the introduction of the Telestroke system did not significantly increase expenditure related to the management of IS compared with direct thrombolysis at the SU. But the distribution of revenues between healthcares centers need to be optimised.