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Tan E, Gao L, Tran HN, Cadilhac D, Bladin C, Moodie M. Telestroke for acute ischaemic stroke: A systematic review of economic evaluations and a de novo cost-utility analysis for a middle income country. J Telemed Telecare 2024; 30:18-30. [PMID: 34292801 DOI: 10.1177/1357633x211032407] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
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.
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Affiliation(s)
- Elise Tan
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia
| | - Lan Gao
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia
| | - Huong Nq Tran
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia
| | - Dominique Cadilhac
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia
| | - Chris Bladin
- 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
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia
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Béjot Y, Soilly AL, Bardou M, Duloquin G, Pommier T, Laurent G, Cottin Y, Vadot L, Adam H, Boulin M, Giroud M. Efficiency and effectiveness of intensive multidisciplinary follow-up of patients with stroke/TIA or myocardial infarction compared to usual monitoring: protocol of a pragmatic randomised clinical trial. DiVa (Dijon vascular) study. BMJ Open 2023; 13:e070197. [PMID: 37185649 PMCID: PMC10151851 DOI: 10.1136/bmjopen-2022-070197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION The ongoing ageing population is associated with an increase in the number of patients suffering a stroke, transient ischaemic attack (TIA) or myocardial infarction (MI). In these patients, implementing secondary prevention is a critical challenge and new strategies need to be developed to close the gap between clinical practice and evidence-based recommendations. We describe the protocol of a randomised clinical trial that aims to evaluate the efficiency and effectiveness of an intensive multidisciplinary follow-up of patients compared with standard care. METHODS AND ANALYSIS The DiVa study is a randomised, prospective, controlled, multicentre trial including patients >18 years old with a first or recurrent stroke (ischaemic or haemorrhagic) or TIA, or a type I or II MI, managed in one of the participating hospitals of the study area, with a survival expectancy >12 months. Patients will be randomised with an allocation ratio of 1:1 in two parallel groups: one group assigned to a multidisciplinary, nurse-based and pharmacist-based 2-year follow-up in association with general practitioners, neurologists and cardiologists versus one group with usual follow-up. In each group for each disease (stroke/TIA or MI), 430 patients will be enrolled (total of 1720 patients) over 3 years. The primary outcome will be the incremental cost-utility ratio at 24 months between intensive and standard follow-up in a society perspective. Secondary outcomes will include the incremental cost-utility ratio at 6 and 12 months, the incremental cost-effectiveness ratio at 24 months, reduction at 6, 12 and 24 months of the rates of death, unscheduled rehospitalisation and iatrogenic complications, changes in quality of life, net budgetary impact at 5 years of the intensive follow-up on the national health insurance perspective and analysis of factors having positive or negative effects on the implementation of the project in the study area. ETHICS AND DISSEMINATION Ethical approval was obtained and all patients receive information about the study and give their consent to participate before randomisation. Results of the main trial and each of the secondary analyses will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT04188457. Registered on 6 December 2019.
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Affiliation(s)
- Yannick Béjot
- Neurology, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Anne-Laure Soilly
- Department of Clinical Research and Innovation, Clinical Research Unit-Methodological Support Network (USMR), University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Marc Bardou
- Gastroenterology, University Hospital Centre Dijon Bourgogne, Dijon, France
- CIC-Inserm 1432, University of Burgundy, Dijon, France
| | - Gauthier Duloquin
- Neurology, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Thibaut Pommier
- Cardiology, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Gabriel Laurent
- Cardiology, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Yves Cottin
- Cardiology, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Lucie Vadot
- Pharmacy, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Héloïse Adam
- Pharmacy, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Mathieu Boulin
- Pharmacy, University Hospital Centre Dijon Bourgogne, Dijon, France
| | - Maurice Giroud
- Neurology, University Hospital Centre Dijon Bourgogne, Dijon, France
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Nguyen CP, Maas WJ, van der Zee DJ, Uyttenboogaart M, Buskens E, Lahr MMH. Cost-effectiveness of improvement strategies for reperfusion treatments in acute ischemic stroke: a systematic review. BMC Health Serv Res 2023; 23:315. [PMID: 36998011 PMCID: PMC10064746 DOI: 10.1186/s12913-023-09310-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Reducing delays along the acute stroke pathway significantly improves clinical outcomes for acute ischemic stroke patients eligible for reperfusion treatments. The economic impact of different strategies reducing onset to treatment (OTT) is crucial information for stakeholders in acute stroke management. This systematic review aimed to provide an overview on the cost-effectiveness of several strategies to reduce OTT. METHODS A comprehensive literature search was conducted in EMBASE, PubMed, and Web of Science until January 2022. Studies were included if they reported 1/ stroke patients treated with intravenous thrombolysis and/or endovascular thrombectomy, 2/ full economic evaluation, and 3/ strategies to reduce OTT. The Consolidated Health Economic Evaluation Reporting Standards statement was applied to assess the reporting quality. RESULTS Twenty studies met the inclusion criteria, of which thirteen were based on cost-utility analysis with the incremental cost-effectiveness ratio per quality-adjusted life year gained as the primary outcome. Studies were performed in twelve countries focusing on four main strategies: educational interventions, organizational models, healthcare delivery infrastructure, and workflow improvements. Sixteen studies showed that the strategies concerning educational interventions, telemedicine between hospitals, mobile stroke units, and workflow improvements, were cost-effective in different settings. The healthcare perspective was predominantly used, and the most common types of models were decision trees, Markov models and simulation models. Overall, fourteen studies were rated as having high reporting quality (79%-94%). CONCLUSIONS A wide range of strategies aimed at reducing OTT is cost-effective in acute stroke care treatment. Existing pathways and local characteristics need to be taken along in assessing proposed improvements.
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Affiliation(s)
- Chi Phuong Nguyen
- Department of Operations, Faculty of Economics and Business, University of Groningen, Groningen, the Netherlands.
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
- Department of Pharmaceutical Administration and Economics, Hanoi University of Pharmacy, Hanoi, Vietnam.
| | - Willemijn J Maas
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Durk-Jouke van der Zee
- Department of Operations, Faculty of Economics and Business, University of Groningen, Groningen, the Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Maarten Uyttenboogaart
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Radiology, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Erik Buskens
- Department of Operations, Faculty of Economics and Business, University of Groningen, Groningen, the Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Maarten M H Lahr
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Mazzuca D, Borselli M, Gratteri S, Zampogna G, Feola A, Della Corte M, Guarna F, Scorcia V, Giannaccare G. Applications and Current Medico-Legal Challenges of Telemedicine in Ophthalmology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095614. [PMID: 35565003 PMCID: PMC9101177 DOI: 10.3390/ijerph19095614] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/29/2022] [Accepted: 05/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The digital revolution is redesigning the healthcare model, and telemedicine offers a good example of the best cost-effectiveness ratio. The COVID-19 pandemic has catalysed the use of the telemedicine. The aim of this review is to describe and discuss the role and the main applications of telemedicine in the ophthalmic clinical practice as well as the related medico-legal aspects. METHODS 45 original articles and 5 reviews focused on this topic and published in English language from 1997 and 2021 were searched on the online databases of Pubmed, Scopus, Web of Sciences and Embase, by using the following key words: "telemedicine", "privacy", "ophthalmology", "COVID-19" and "informed consent". RESULTS Telemedicine is able to guarantee patient care using information and communication technologies. Technology creates an opportunity to link doctors with the aim of assessing clinical cases and maintaining high standards of care while performing and saving time as well. Ophthalmology is one of the fields in which telemedicine is most commonly used for patient management. CONCLUSIONS Telemedicine offers benefits to patients in terms of saving time and costs and avoiding physical contact; however, it is necessary to point out significant limitations such as the absence of physical examinations, the possibility of transmission failure and potential violations of privacy and confidentiality.
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Affiliation(s)
- Daniela Mazzuca
- Department of Surgical and Medical Sciences, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.M.); (S.G.); (M.D.C.); (F.G.)
| | - Massimiliano Borselli
- Department of Ophthalmology, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (M.B.); (V.S.)
| | - Santo Gratteri
- Department of Surgical and Medical Sciences, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.M.); (S.G.); (M.D.C.); (F.G.)
| | - Giovanna Zampogna
- Department of Law, Economics and Human Sciences (DIGIES), Mediterranea University of Reggio Calabria, Via dell’Università 25, 89124 Reggio Calabria, Italy;
| | - Alessandro Feola
- Department of Experimental Medicine, University of Campania ‘Luigi Vanvitelli’, Via Luciano Armanni 5, 80138 Naples, Italy;
| | - Marcello Della Corte
- Department of Surgical and Medical Sciences, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.M.); (S.G.); (M.D.C.); (F.G.)
| | - Francesca Guarna
- Department of Surgical and Medical Sciences, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.M.); (S.G.); (M.D.C.); (F.G.)
| | - Vincenzo Scorcia
- Department of Ophthalmology, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (M.B.); (V.S.)
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (M.B.); (V.S.)
- Correspondence: ; Tel.: +39-0961-3647-041; Fax: +39-0961-3647-094
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Ohannessian R, Schott AM, Colin C, Nighoghossian N, Medeiros de Bustos E, Moulin T. Acute telestroke in France: A systematic review. Rev Neurol (Paris) 2020; 176:316-324. [PMID: 32147201 DOI: 10.1016/j.neurol.2019.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/12/2019] [Accepted: 11/18/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Acute telestroke is the use of telemedicine to improve acute stroke care. It has demonstrated to be a safe and effective medical practice. Since 2011, acute telestroke has been promoted by the Ministry of Health in France, and in 2018 many regions were in the process or completion of implementing telestroke. The objective of this study was to describe acute telestroke implementation in France. METHODS A systematic review was conducted using PubMed and ScienceDirect databases. Articles and abstracts in English and French, published between January 1st, 2000 to April 30th, 2018 were used. Studies conducted in France and that had presented an outcome evaluation of a regional acute telestroke activity were included. No meta-analysis was conducted. RESULTS A total of 24 studies (14 in French, 10 in English) were included, with 13 published articles (7 indexed on PubMed) and 11 abstracts. Among the 13 published articles, there were seven observational retrospective studies, one quasi-experimental before-after study, one experimental randomised controlled trial, and four medico-economic studies. All telestroke network models of care were drip-and-ship with hub and spoke organisation. The case-control studies did not show a difference with or without telemedicine. The territorial thrombolysis rate was measured in two regions, with an increase in Franche-Comté from 0.2% (2004) to 9.9% (2015), and a relative increase of 76% in Nord-Pas-de-Calais between 2009-2010 and 2012. CONCLUSION Implementation of acute telestroke in France had a positive clinical and public health impact but the evaluation remained limited and needs to be supported.
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Affiliation(s)
- R Ohannessian
- CIC-1431 Inserm département de Neurologie, EA 481 laboratoire de neurosciences intégratives et cliniques université de Franche-Comté, UBFC, CHRU de Besançon, Besançon, France; Télémédecine 360, TLM360, Paris, France.
| | - A-M Schott
- HESPER EA 7425, université Lyon, université Claude Bernard Lyon 1, 69008 Lyon, France; Pôle IMER, hospices civils de Lyon, 69003 Lyon, France
| | - C Colin
- HESPER EA 7425, université Lyon, université Claude Bernard Lyon 1, 69008 Lyon, France; Pôle IMER, hospices civils de Lyon, 69003 Lyon, France
| | - N Nighoghossian
- Unité neurovasculaire, hôpital Pierre-Wertheimer, hospices Civils de Lyon, 69677 Bron cedex, France
| | | | - T Moulin
- Department of Neurology, University Hospital of Besançon, Besançon, France; French Society of Telemedicine, Paris, France
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