Ehlers Lars, Müskens Wilhelmina Maria, Jensen Lotte Groth, Kjølby Mette, Andersen Grethe
HTA Unit, Aarhus University Hospital, Aarhus, Denmark.
CNS Drugs. 2008;22(1):73-81. doi: 10.2165/00023210-200822010-00006.
The purpose of this analysis was to assess the budgetary impact and cost effectiveness of the national use of thrombolysis with alteplase (recombinant tissue plasminogen activator; rt-PA) for acute ischaemic stroke via telemedicine in Denmark.
Computations were based on a Danish health economic model of thrombolysis treatment of acute ischaemic stroke via telemedicine. Cost data for stroke units and satellite clinics were taken from the first practical experiences in Denmark with implementing thrombolysis via telemedical linkage to the Stroke Department at Aarhus University Hospital. Effectiveness data were taken from a published pooled analysis of results from randomized controlled trials of alteplase.
The calculations showed that the additional total costs to the hospitals of implementing thrombolysis with alteplase for acute ischaemic stroke via telemedicine were approximately $US3.0 (range 2.0-5.8) million per year in the case of five centres and five satellite clinics, or $US3.6 (range 2.4-7.0) million per year based on seven centres and seven satellite clinics. The incremental cost-effectiveness ratio was calculated to be approximately $US50,000 when taking a short time perspective (1 year), but thrombolysis was dominant (both cheaper and more effective) after as little as 2 years and cost effectiveness improved over longer time scales.
The budgetary impact of using thrombolysis with alteplase for acute ischaemic stroke via telemedicine depends on the existing capacity and organizational conditions at the local hospitals. The health economic model computations suggest that the macroeconomic costs may balance with savings in care and rehabilitation after as little as 2 years, and that potentially large long-term savings are associated with thrombolysis with alteplase delivered by telemedicine, although the long-term calculations are uncertain.
本分析旨在评估丹麦通过远程医疗在全国范围内使用阿替普酶（重组组织型纤溶酶原激活剂；rt-PA）进行急性缺血性卒中溶栓治疗的预算影响和成本效益。
计算基于丹麦通过远程医疗进行急性缺血性卒中溶栓治疗的健康经济模型。卒中单元和卫星诊所的成本数据取自丹麦通过与奥胡斯大学医院卒中科的远程医疗联系实施溶栓治疗的首批实际经验。有效性数据取自已发表的阿替普酶随机对照试验结果的汇总分析。
计算表明，对于五个中心和五个卫星诊所，通过远程医疗使用阿替普酶进行急性缺血性卒中溶栓治疗，医院每年额外的总成本约为300万美元（范围为200万至580万美元）；基于七个中心和七个卫星诊所，每年约为360万美元（范围为240万至700万美元）。从短期（1年）来看，增量成本效益比计算约为50,000美元，但仅2年后溶栓治疗就占主导地位（成本更低且更有效），并且在更长的时间范围内成本效益有所提高。
通过远程医疗使用阿替普酶进行急性缺血性卒中溶栓治疗的预算影响取决于当地医院的现有能力和组织条件。健康经济模型计算表明，宏观经济成本可能在短短2年后就与护理和康复方面的节省相平衡，并且通过远程医疗进行阿替普酶溶栓治疗可能会带来潜在的大量长期节省，尽管长期计算存在不确定性。
