Laboratoire d'Économie de Dijon, EA (7467), Université de Bourgogne-Franche-Comté, Pôle d'Economie et de Gestion, 2 bd Gabriel - BP 26 611, 21066Dijon cedex, France.
Dijon Stroke Registry, EA7460, Dijon University Hospital, University of Burgundy and Medical School of Dijon, Dijon, France.
Int J Technol Assess Health Care. 2020 Apr;36(2):126-132. doi: 10.1017/S0266462320000057. Epub 2020 Mar 2.
Telestroke is an effective way to improve care and health outcomes for stroke patients. This study evaluates the cost-effectiveness of a French telestroke network.
A decision analysis model was built using population-based data. We compared short-term clinical outcomes and costs for the management of acute ischemic stroke patients before and after the implementation of a telestroke network from the point of view of the national health insurance system. Three effectiveness endpoints were used: hospital death, death at 3 months, and severe disability 3 months after stroke (assessed with the modified Rankin scale). Most clinical and economic parameters were estimated from the medical files of 742 retrospectively included patients. Sensitivity analyses were performed.
The analyses revealed that the telestroke strategy was more effective and slightly more costly than the reference strategy (25 disability cases avoided per 1,000 at 3 months, 6.7 avoided hospital deaths, and 13 avoided deaths at 3 months for an extra cost of EUR 97, EUR 138, and EUR 154, respectively). The results remained robust in the sensitivity analyses.
In France, telestroke is an effective strategy for improving patient outcomes and, despite the extra cost, it has a legitimate place in the national health care system.
远程卒中是改善卒中患者护理和健康结局的有效方法。本研究评估了法国远程卒中网络的成本效益。
使用基于人群的数据构建决策分析模型。我们从国家健康保险体系的角度，比较了在远程卒中网络实施前后急性缺血性卒中患者管理的短期临床结局和成本。使用三个有效性终点：医院死亡、3 个月死亡和卒中后 3 个月严重残疾（用改良 Rankin 量表评估）。大多数临床和经济参数是从 742 名回顾性纳入患者的病历中估算的。进行了敏感性分析。
分析表明，远程卒中策略比参考策略更有效且略贵（每 1000 例患者在 3 个月时可避免 25 例残疾，可避免 6.7 例医院死亡，可避免 13 例 3 个月死亡，额外费用分别为 97 欧元、138 欧元和 154 欧元）。敏感性分析结果仍然稳健。
在法国，远程卒中是改善患者结局的有效策略，尽管成本增加，但它在国家医疗保健系统中具有合理的地位。
