Cost effectiveness analysis of the East of England stroke telemedicine service

Abstract

Introduction: Stroke is the fourth single leading cause of death in the UK with more than 100,000 people diagnosed with stroke annually. Timely access to urgent care and treatments, such as thrombolysis, is crucial for survival and recovery but there are national variations in care access.

Materials and methods: We explore the cost-effectiveness of an integrated telemedicine service for rapid access to stroke Consultant support in the East of England acute stroke care pathway compared to usual care during out-of-hour periods. The Sentinel Stroke National Audit Programme (SSNAP) health economics thrombolysis tool enabled us to compare the service with usual acute stroke care pathway. The tool was used to estimate costs and cost per quality-adjusted life year (QALY) gain associated with improved thrombolysis rates from a health and social care perspective.

Results: Based on SSNAP data, an average of 1,861 stroke patients were admitted out-of-hours in the participating centres annually between 2014 and 2019. Average thrombolysis rate was 9.7% when using a telemedicine service across the centres relative to the total stroke patients that presented out-of-hours. The total NHS cost savings compared to usual care were estimated at £482k and £471k while social care cost savings were £1.7m and £536k at the end of 1-year and 5-years respectively.

Conclusion: Integrating a telemedicine service improves thrombolysis rates in out-of-hours acute stroke care and is associated with NHS and social care savings and QALY gains. Telemedicine is a cost-effective approach to delivering stroke care to remote communities with limited access to stroke specialists.

Keywords: Cost effectiveness; Economic evaluation; Quality of life; Stroke; Telemedicine; Thrombolysis.