National Use of Thrombolysis with Alteplase for Acute Ischaemic Stroke via Telemedicine in Denmark: A Model of Budgetary Impact and Cost Effectiveness
Aim: 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. Methods: Computations were based on a Danish health...
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creator | Ehlers, Lars Müskens, Wilhelmina Maria Jensen, Lotte Groth Kjølby, Mette Andersen, Grethe |
description | Aim:
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.
Methods:
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.
Results:
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.
Conclusion:
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. |
doi_str_mv | 10.2165/00023210-200822010-00006 |
format | Article |
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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.
Methods:
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.
Results:
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.
Conclusion:
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.</description><identifier>ISSN: 1172-7047</identifier><identifier>EISSN: 1179-1934</identifier><identifier>DOI: 10.2165/00023210-200822010-00006</identifier><identifier>PMID: 18072816</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Aged ; Biological and medical sciences ; Brain Ischemia - complications ; Budgets ; Cardiovascular system ; Cerebral Hemorrhage - epidemiology ; Cost analysis ; Cost control ; Cost of Illness ; Cost-Benefit Analysis ; Denmark - epidemiology ; Drug Costs ; Drug Utilization ; Female ; Fibrinolytic Agents - economics ; Fibrinolytic Agents - therapeutic use ; Hospitals ; Humans ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Models, Economic ; Mortality ; Neurology ; Neurosciences ; Original Research Article ; Patients ; Pharmacology. Drug treatments ; Pharmacotherapy ; Psychiatry ; Psychopharmacology ; Quality-Adjusted Life Years ; Randomized Controlled Trials as Topic ; Rehabilitation ; Stroke ; Stroke - drug therapy ; Stroke - economics ; Stroke - epidemiology ; Studies ; t-Plasminogen activator ; Telemedicine ; Telemedicine - economics ; Telemedicine - statistics & numerical data ; Thrombolysis ; Tissue Plasminogen Activator - economics ; Tissue Plasminogen Activator - therapeutic use ; Vascular diseases and vascular malformations of the nervous system ; Vasodilator agents. Cerebral vasodilators</subject><ispartof>CNS drugs, 2008, Vol.22 (1), p.73-81</ispartof><rights>Adis Data Information BV 2008</rights><rights>2008 INIST-CNRS</rights><rights>COPYRIGHT 2008 Wolters Kluwer Health, Inc.</rights><rights>Copyright Springer Nature B.V. Jan 2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3796-a18b5e4d46db94869d04bf792db87c9788de96786a75af57484e1555da71d4e03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.2165/00023210-200822010-00006$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.2165/00023210-200822010-00006$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,4024,27923,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19924400$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18072816$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ehlers, Lars</creatorcontrib><creatorcontrib>Müskens, Wilhelmina Maria</creatorcontrib><creatorcontrib>Jensen, Lotte Groth</creatorcontrib><creatorcontrib>Kjølby, Mette</creatorcontrib><creatorcontrib>Andersen, Grethe</creatorcontrib><title>National Use of Thrombolysis with Alteplase for Acute Ischaemic Stroke via Telemedicine in Denmark: A Model of Budgetary Impact and Cost Effectiveness</title><title>CNS drugs</title><addtitle>CNS Drugs</addtitle><addtitle>CNS Drugs</addtitle><description>Aim:
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.
Methods:
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.
Results:
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.
Conclusion:
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.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Brain Ischemia - complications</subject><subject>Budgets</subject><subject>Cardiovascular system</subject><subject>Cerebral Hemorrhage - epidemiology</subject><subject>Cost analysis</subject><subject>Cost control</subject><subject>Cost of Illness</subject><subject>Cost-Benefit Analysis</subject><subject>Denmark - epidemiology</subject><subject>Drug Costs</subject><subject>Drug Utilization</subject><subject>Female</subject><subject>Fibrinolytic Agents - economics</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Models, Economic</subject><subject>Mortality</subject><subject>Neurology</subject><subject>Neurosciences</subject><subject>Original Research Article</subject><subject>Patients</subject><subject>Pharmacology. Drug treatments</subject><subject>Pharmacotherapy</subject><subject>Psychiatry</subject><subject>Psychopharmacology</subject><subject>Quality-Adjusted Life Years</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Rehabilitation</subject><subject>Stroke</subject><subject>Stroke - drug therapy</subject><subject>Stroke - economics</subject><subject>Stroke - epidemiology</subject><subject>Studies</subject><subject>t-Plasminogen activator</subject><subject>Telemedicine</subject><subject>Telemedicine - economics</subject><subject>Telemedicine - statistics & numerical data</subject><subject>Thrombolysis</subject><subject>Tissue Plasminogen Activator - economics</subject><subject>Tissue Plasminogen Activator - therapeutic use</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><subject>Vasodilator agents. Cerebral vasodilators</subject><issn>1172-7047</issn><issn>1179-1934</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqFkk1v1DAQhiMEoqXwF5AlBLcU2_HncdVSqFTBge3ZcpxJ160TL3YC6r-v011YgZAqHzyaeWY0euetKkTwKSWCf8QY04YSXFOMFaW4RCWFxbPqmBCpa6Ib9vwxprXETB5Vr3K-LQRrhHhZHRGFJVVEHFftVzv5ONqArjOg2KP1JsWhjeE--4x--WmDVmGCbbCl3MeEVm6eAF1mt7EweIe-TyneAfrpLVpDgAE67_wIyI_oHMbBprvX1Yvehgxv9v9JdX3xaX32pb769vnybHVVu0ZqUVuiWg6sY6JrNVNCd5i1vdS0a5V0WirVgRZSCSu57blkigHhnHdWko4Bbk6qD7u52xR_zJAnM_jsIAQ7QpyzkUUmugj3FEgxo5LxBXz3D3gb51TEKgzVWgoqGn6gbmwA48c-Tsm6ZaRZEa2V4JqrQp3-hyqvW2SMI_S-5P9qULsGl2LOCXqzTb7oeW8INosLzG8XmD8uMI8uKK1v93vPbTnIoXF_9gK83wM2Oxv6ZEfn84HTmjKGF0n1jsulNN5AOgjw5BIPW-XHDA</recordid><startdate>2008</startdate><enddate>2008</enddate><creator>Ehlers, Lars</creator><creator>Müskens, Wilhelmina Maria</creator><creator>Jensen, Lotte Groth</creator><creator>Kjølby, Mette</creator><creator>Andersen, Grethe</creator><general>Springer International Publishing</general><general>Adis International</general><general>Wolters Kluwer Health, Inc</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>7QP</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>2008</creationdate><title>National Use of Thrombolysis with Alteplase for Acute Ischaemic Stroke via Telemedicine in Denmark</title><author>Ehlers, Lars ; Müskens, Wilhelmina Maria ; Jensen, Lotte Groth ; Kjølby, Mette ; Andersen, Grethe</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3796-a18b5e4d46db94869d04bf792db87c9788de96786a75af57484e1555da71d4e03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Brain Ischemia - complications</topic><topic>Budgets</topic><topic>Cardiovascular system</topic><topic>Cerebral Hemorrhage - epidemiology</topic><topic>Cost analysis</topic><topic>Cost control</topic><topic>Cost of Illness</topic><topic>Cost-Benefit Analysis</topic><topic>Denmark - epidemiology</topic><topic>Drug Costs</topic><topic>Drug Utilization</topic><topic>Female</topic><topic>Fibrinolytic Agents - economics</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Models, Economic</topic><topic>Mortality</topic><topic>Neurology</topic><topic>Neurosciences</topic><topic>Original Research Article</topic><topic>Patients</topic><topic>Pharmacology. Drug treatments</topic><topic>Pharmacotherapy</topic><topic>Psychiatry</topic><topic>Psychopharmacology</topic><topic>Quality-Adjusted Life Years</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Rehabilitation</topic><topic>Stroke</topic><topic>Stroke - drug therapy</topic><topic>Stroke - economics</topic><topic>Stroke - epidemiology</topic><topic>Studies</topic><topic>t-Plasminogen activator</topic><topic>Telemedicine</topic><topic>Telemedicine - economics</topic><topic>Telemedicine - statistics & numerical data</topic><topic>Thrombolysis</topic><topic>Tissue Plasminogen Activator - economics</topic><topic>Tissue Plasminogen Activator - therapeutic use</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><topic>Vasodilator agents. Cerebral vasodilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ehlers, Lars</creatorcontrib><creatorcontrib>Müskens, Wilhelmina Maria</creatorcontrib><creatorcontrib>Jensen, Lotte Groth</creatorcontrib><creatorcontrib>Kjølby, Mette</creatorcontrib><creatorcontrib>Andersen, Grethe</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>CNS drugs</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ehlers, Lars</au><au>Müskens, Wilhelmina Maria</au><au>Jensen, Lotte Groth</au><au>Kjølby, Mette</au><au>Andersen, Grethe</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>National Use of Thrombolysis with Alteplase for Acute Ischaemic Stroke via Telemedicine in Denmark: A Model of Budgetary Impact and Cost Effectiveness</atitle><jtitle>CNS drugs</jtitle><stitle>CNS Drugs</stitle><addtitle>CNS Drugs</addtitle><date>2008</date><risdate>2008</risdate><volume>22</volume><issue>1</issue><spage>73</spage><epage>81</epage><pages>73-81</pages><issn>1172-7047</issn><eissn>1179-1934</eissn><abstract>Aim:
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.
Methods:
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.
Results:
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.
Conclusion:
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.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>18072816</pmid><doi>10.2165/00023210-200822010-00006</doi><tpages>9</tpages></addata></record> |
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source | MEDLINE; SpringerLink Journals |
subjects | Aged Biological and medical sciences Brain Ischemia - complications Budgets Cardiovascular system Cerebral Hemorrhage - epidemiology Cost analysis Cost control Cost of Illness Cost-Benefit Analysis Denmark - epidemiology Drug Costs Drug Utilization Female Fibrinolytic Agents - economics Fibrinolytic Agents - therapeutic use Hospitals Humans Male Medical sciences Medicine Medicine & Public Health Models, Economic Mortality Neurology Neurosciences Original Research Article Patients Pharmacology. Drug treatments Pharmacotherapy Psychiatry Psychopharmacology Quality-Adjusted Life Years Randomized Controlled Trials as Topic Rehabilitation Stroke Stroke - drug therapy Stroke - economics Stroke - epidemiology Studies t-Plasminogen activator Telemedicine Telemedicine - economics Telemedicine - statistics & numerical data Thrombolysis Tissue Plasminogen Activator - economics Tissue Plasminogen Activator - therapeutic use Vascular diseases and vascular malformations of the nervous system Vasodilator agents. Cerebral vasodilators |
title | National Use of Thrombolysis with Alteplase for Acute Ischaemic Stroke via Telemedicine in Denmark: A Model of Budgetary Impact and Cost Effectiveness |
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