Abstract
Background: Over the past decade, tele-stroke networks have been shown to remarkably improve our ability to provide timely treatments for stroke patients. Data on the economic impact of tele-stroke networks are scarce. Our aim is to assess the economic impact associated with the adoption of tele-stroke in local, geographically defined areas in the state of South Carolina (SC). Methods: Data were extracted from SC All-payer hospital discharges database from 2014-1017. Patients included were admitted with primary diagnosis ICD-9 codes for acute ischemic stroke. SC tele-stroke tracking data was used to assign county exposure. Data was analyzed using multivariable logistic, Poisson and gamma regression models with robust error variance in Proc Genmod to estimate effects. Multiple variables were assessed including tPA treatment, mechanical thrombectomy, and cost of in-hospital and follow up care for readmissions or ED visits in patients that had tele-stroke available in-county compared to those that did not. Results: A total of 33,603 patients were included in these analyses. A total of 2,799 patients received tPA and 695 patients received mechanical thrombectomy. Estimated mean hospital payments were $13,715 (SD $15,742) for patients with tele-stroke available compared to $14,065 (SD $15,477) where tele-stroke was not available (P=0.0002). Total mean payments were significantly higher for patients without tele-stroke availability ($34,560 SD $51,049) compared to patients with tele-stroke available ($31,744, SD $45,517) (P<0.0001). Mean total follow up payments were also calculated and found to be significantly different for patients with tele-stroke available ($30,451, SD $50,367) compared to patients without tele-stroke ($34,258, SD $57,921) (P<0.0001). Conclusion: Our results indicate that tele-stroke presence in geographic locations improves treatment and outcomes in patients with acute ischemic stroke and may be expected to have an economic benefit. We observed a significant population-level association between availability of tele-stroke and mean hospital payments, follow up payments, and follow up ER visit payments.
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