Abstract W MP84: Telestroke Network Cost-Effectiveness in the Pacific Northwest: Geography and Facility Size Support a Cost-Sharing Model Between Hub and Spoke

Abstract

Background: Stroke care in the Pacific Northwest (PNW) is challenging due to vast distances between small facilities and stroke experts. Regional stroke centers have adopted telestroke to meet this challenge, but often bear the entire cost burden. We sought to determine the effect of distance and facility size on cost-effectiveness of telestroke implementation within our PNW Telestroke Network. Methods: We used a decision analytic model with input parameters obtained from patient-level clinical and hospital costs and reimbursements from the Oregon Providence Telestroke Network using pre- and post-telestroke implementation data. Using a one-year time horizon, we calculated the cost-effectiveness of telestroke for spoke facility characteristics of: (1) stroke volume (</≥ 25/yr), (2) distance to hub facility (</≥ 130 miles), and (3) number of hospital beds (</≥ 70). Data included all acute ischemic stroke patients presenting at the spoke hospitals within 4.5 hours of symptom onset. Probability inputs included IV-tPA treatment rates and transfer status. Effectiveness, measured as quality adjusted life years (QALYs), and costs, were combined to calculate incremental cost effectiveness ratios (ICERs) for the spoke hospitals. ICER’s of <$50,000-$120,000/QALY are considered cost-effective. Outcomes were stratified by percentage of cost burden for implementation by the spoke. Results: See Table 1. Conclusions: Our results suggest that despite the unique characteristics of the PNW, telestroke remained cost effective and the cost effectiveness of telestroke was not affected by bedsize, distance from hub or stroke volumes. Thus, a cost-sharing model may be a feasible solution to telestroke network economic sustainability.