An economic evaluation comparing stroke telemedicine to conventional stroke medicine.
详细信息
- 作者：Budhram ; Stanley Chandra.
- 学历：Doctor
- 年：2011
- 导师：Baugh, Jeanne,eadvisor
- 毕业院校：Robert Morris University
- ISBN：9781267033963
- CBH：3485947
- Country：USA
- 语种：English
- FileSize：4970228
- Pages：133
文摘
Stroke is not only a serious medical problem, but it also poses an enormous economic burden on society. Stroke ranks the third as the leading cause of death in the United States behind heart disease and cancer. The survivors of stroke suffer from various degrees of long-term disability which create a severe financial burden on society. University of Pittsburgh Medical Center UPMC) provides some of the best stroke treatment in the United States, but containing costs of conventional care without compromising access and quality of care remains a challenge. A telemedicine network between UPMC Stroke Institute hub) and selected regional hospitals spokes) was established to address the challenge. This cost-benefits study presents comparing telestroke treatment plan with that of conventional stroke to determine the viability of the telestroke approach. The economic evaluation was designed to inform the decision on whether or not to continue with the telestroke treatment of patients with blocked arteries from acute ischemic stroke. The group of patients selected for telestroke was treated via teleconsultation, whereas the conventional care group was treated at the stroke center. Both groups were evaluated by the same team of neurologists and received similar treatment, during the same period. Functional outcomes were obtained prospectively and were measured using the modified Rankin Scale. A Markov decision analytic model employing the Monte Carlo simulation was used to determine the cost-benefits incremental net monetary benefits) of the two healthcare strategies. The model was constructed by using data obtained from UPMC, Pennsylvania Cost Containment Council, The Federal Long Term Care Insurance Program, and the medical literature. The data was entered into the TreeAge Pro software package version 2011TreeAge Pro Inc. of Williamstown, MA, USA), for modeling. The data was synthesized, processed, and output presented in text, numeric, and graphical form. The results showed that the telestroke treatment cost $14,336 less than that of conventional stroke. Although telestroke was found to be more effective than conventional care, the difference was not significant. Telestroke showed an incremental net monetary benefit over conventional care by $20,387 when the willingness to pay WTP) value was set at $86,461. The WTP was based on the statistical value of life established by the EPA as $6.9 million, and an average life expectancy of 78 years. Telestroke is a viable alternative to conventional care for treating acute ischemic stroke with IVtPA, if the treatment is accomplished within three hours of the initial onset of stroke, and when a vascular neurologist is not readily available at the spoke site.