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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Veröffentlicht in:CNS drugs 2008, Vol.22 (1), p.73-81
Hauptverfasser: Ehlers, Lars, Müskens, Wilhelmina Maria, Jensen, Lotte Groth, Kjølby, Mette, Andersen, Grethe
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container_issue 1
container_start_page 73
container_title CNS drugs
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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.
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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. 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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. 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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 &amp; Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Health &amp; 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 &amp; Medical Complete (Alumni)</collection><collection>Health &amp; 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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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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