Telestroke for acute ischaemic stroke: A systematic review of economic evaluations and a de novo cost-utility analysis for a middle income country.

Autor:	Tan E; Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia., Gao L; Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia., Tran HN; Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia., Cadilhac D; Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia., Bladin C; Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Australia.; Public Health and Health Services Research, The Florey Institute Neuroscience and Mental Health, University of Melbourne, Australia.; Ambulance Victoria, Australia.; Eastern Health Clinical School, Monash University, Australia., Moodie M; Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia.
Jazyk:	angličtina
Zdroj:	Journal of telemedicine and telecare [J Telemed Telecare] 2024 Jan; Vol. 30 (1), pp. 18-30. Date of Electronic Publication: 2021 Jul 22.
DOI:	10.1177/1357633X211032407
Abstrakt:	Introduction: Telemedicine can alleviate the problems faced in rural settings in providing access to specialist stroke care. The evidence of the cost-effectiveness of this model of care outside high-income countries is limited. This study aimed to conduct: (a) a systematic review of economic evaluations of telestroke and (b) a cost-utility analysis of telestroke, using China as a case study. Methods: We systematically searched Embase, Medline Complete and Cochrane databases. Inclusion criteria: full economic evaluations of telemedicine/telestroke networks examining the use of thrombolysis in patients with acute ischaemic stroke, published in English. A cost-utility analysis was undertaken using a Markov model incorporating a decision tree to simulate the delivery of telestroke for acute ischaemic stroke in rural China, compared to no telestroke from a societal and healthcare perspective. One-way deterministic sensitivity analyses and probabilistic sensitivity analyses were performed to test the robustness of results. Results: Of 559 publications found, eight met the eligibility criteria and were included in the systematic review (two cost-effectiveness analyses and six cost-utility analyses, all performed in high-income countries). Telestroke was a cost-saving/cost-effective intervention in five out of the eight studies. In our modelled analysis for rural China, telestroke was the dominant strategy, with estimated cost savings of Chinese yuan 4,328 (US$627) and additional 0.0925 quality-adjusted life years per patient. Sensitivity analyses confirmed the base case results. Discussion: Consistent with published economic evaluations of telestroke in other jurisdictions, telestroke represents a cost-effective solution to enhance stroke care in rural China. Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Databáze:	MEDLINE
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