One-Year Costs Associated With the Veterans Affairs National TeleStroke Program

• Published in: Value in health Vol. 25; no. 6; pp. 937 - 943
• Main Authors: Wagner, Todd H., Schoemaker, Lena, Gehlert, Elizabeth, Nelson, Richard E., Murphy, Katherine, Martini, Sharyl, Graham, Glenn D., Govindarajan, Prasanthi, Williams, Linda S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2022
• Subjects: access; costs; Costs and Cost Analysis; Emergency Service, Hospital; Fibrinolytic Agents - therapeutic use; Humans; stroke; Stroke - economics; Stroke - therapy; Telemedicine; Tissue Plasminogen Activator - therapeutic use; Veterans; costs; stroke; access
• ISSN: 1098-3015; 1524-4733; 1524-4733
• DOI: 10.1016/j.jval.2022.02.010

Access to timely care is important for patients with stroke, where rapid diagnosis and treatment affect functional status, disability, and mortality. Telestroke programs connect stroke specialists with emergency department staff at facilities without on-site stroke expertise. The objective of this study was to examine healthcare costs for patients with stroke who sought care before and after implementation of the US Department of Veterans Affairs National TeleStroke Program (NTSP). We identified 471 patients who had a stroke and sought care at a telestroke site and compared them to 529 patients with stroke who received stroke care at the same sites before telestroke implementation. We examined patient costs for 12 months before and after stroke, using a linear model with a patient-level fixed effect. NTSP was associated with significantly higher rates of patients receiving guideline concordant care. Compared with control patients, those treated by NTSP were 14.3 percentage points more likely to receive tissue plasminogen activator and 4.3 percentage points more likely to receive a thrombectomy (all P < .0001). NTSP was associated with $4821 increased costs for patients with stroke in the first 30 days after the program (2019 dollars). There were no observed savings over 12 months, and the added costs of care were attributable to higher rates of guideline concordant care. Telestroke programs are unlikely to yield short-term savings because optimal stroke care is expensive. Healthcare organizations should expect increases in healthcare costs for patients treated for stroke in the first year after implementing a telestroke program. •Stroke care, where timely access and treatment, can have a large impact on functional status, disability, and mortality. Many veterans are at higher than average risk of stroke because of comorbidities and risk factors. Veterans who have a stroke and present acutely to a Veterans Affairs medical center, particularly in rural areas, may not have emergency access to stroke specialists.•Previous work estimating the cost-effectiveness of telestroke has used simulations that synthesize evidence from different sources. Our analysis uses patient-level data for patients who present at telestroke spokes, and we find that National TeleStroke Program added costs, but were cost-effective because of the positive gains in health outcomes. Some models only included patients with stroke presenting early enough for acute stroke treatment, whereas here we included all patients with stroke regardless of time from stroke onset to presentation.•This work sheds light on the underlying motivations for creating telestroke programs. The National TeleStroke Program was associated with increased downstream costs and evidence of higher rates of optimal stroke care. The results suggest that new telestroke programs are unlikely to yield short-term savings and these added costs should be considered when implementing a telestroke program.