Making the call: is telestroke cost effective?

Abstract

Evaluation of: Nelson RE, Saltzman GM, Skalabrin EJ, Demaerschalk BM, Majersik JJ. The cost–effectiveness of telestroke in the treatment of acute ischaemic stroke. Neurology 77, 1590–1598 (2011).The clinical efficacy of intravenous tissue plasminogen activator (tPA) in acute ischemic stroke is proven, and the cost-efficacy of tPA is realized through reduction in disability and associated long-term care. Only a modest proportion of eligible stroke patients receive tPA. Potential barriers include distance from treatment centers and lack of local expertise and infrastructure. Nelson and colleagues describe a telecommunications strategy to facilitate increased delivery of thrombolysis. The analysis used a model based on an expert stroke-center ‘hub’ offering video-based liaison with several peripheral hospital ‘spokes’. Economic modeling suggested cost efficacy of this approach, albeit with all the caveats that come with long-term economic analyses of an acute stroke intervention. There is a clinical, ethical and economical imperative to increase uptake of evidence-based acute stroke therapies. These encouraging data suggest that use of audiovisual technologies may facilitate greater access to thrombolysis.