Department of Neurology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
Am J Manag Care. 2010 Jul;16(7):537-44.
To conduct a systematic literature review analyzing cost-effectiveness or cost savings associated with use of recombinant tissue plasminogen activator (rt-PA), stroke centers, and telemedicine programs for acute ischemic stroke.
A literature search was conducted of the PubMed/MEDLINE and Ovid/EMBASE databases from January 1, 1995, to August 30, 2008, limited to English-language articles and using the search terms [stroke and cost and telemedicine] or [stroke and cost and alteplase] or [stroke and cost and tissue plasminogen activator] or [stroke and cost and rt-PA] or [stroke center and cost] or [stroke unit and cost]. Abstracts were reviewed, and inclusion/exclusion criteria were used to select studies. The analysis was limited to studies addressing costs or cost-effectiveness of the interventions in the United States.
This search identified 748 abstracts, of which 24 were included. Among these 24 studies were 2 cost-effectiveness, 8 cost-savings, and 4 cost-benefit analyses. All discussed some aspect of practice economics. The primary cost-effectiveness data available for rt-PA use demonstrated increased hospitalization costs but long-term cost savings due to decreased nursing home and rehabilitation costs. No cost-effectiveness studies for stroke centers or telemedicine programs were identified, although stroke centers have been shown to reduce hospital length of stay and both stroke centers and telemedicine programs have demonstrated increased rates of rt-PA administration within 3 hours of the onset of stroke symptoms.
More high-quality, current cost-effectiveness research for stroke centers, care networks, and telemedicine is needed to inform treatment decisions and resource utilization.
对与急性缺血性脑卒中使用重组组织型纤溶酶原激活剂（rt-PA）、卒中中心和远程医疗项目相关的成本效益或成本节约进行系统文献回顾分析。
对 1995 年 1 月 1 日至 2008 年 8 月 30 日期间的 PubMed/MEDLINE 和 Ovid/EMBASE 数据库进行了文献检索，限定为英文文章，并使用了以下检索词：[stroke and cost and telemedicine]或[stroke and cost and alteplase]或[stroke and cost and tissue plasminogen activator]或[stroke and cost and rt-PA]或[stroke center and cost]或[stroke unit and cost]。对摘要进行了回顾，并使用纳入/排除标准选择了研究。分析仅限于在美国进行的干预措施的成本或成本效益研究。
此次搜索共确定了 748 篇摘要，其中有 24 篇被纳入。在这 24 项研究中，有 2 项是成本效益分析，8 项是成本节约分析，4 项是成本效益分析。所有研究都讨论了实践经济学的某个方面。目前可获得的 rt-PA 使用的主要成本效益数据表明，住院费用增加，但由于疗养院和康复费用降低，长期成本节约。尚未确定卒中中心或远程医疗项目的成本效益研究，但卒中中心已被证明可缩短住院时间，卒中中心和远程医疗项目均已证明可增加卒中症状发作后 3 小时内 rt-PA 的使用率。
需要更多高质量、最新的关于卒中中心、护理网络和远程医疗的成本效益研究，以辅助治疗决策和资源利用。
