Hub-and-spoke telestroke network cost-effective

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 - Stroke, endovascular. neuroimaging, neuro

A study analyzing the cost-effectiveness of a telestroke network model with one hub and seven spoke hospitals found that with a target 30 percent transfer rate, the arrangement was cost effective for the hub, the spokes and the network as a whole. The results of the study were published online Dec. 4 in Circulation Cardiovascular Quality and Outcomes.

Hub-and-spoke telestroke networks can extend high quality stroke care to rural hospitals that may not have access to stroke specialists or the capacity to offer endovascular revascularization strategies. Other studies have confirmed that such networks improve patient outcomes, but no studies have analyzed the cost-effectiveness of a telestroke network from the perspective of each component facility and the network as a whole. Because telestroke networks are proliferating and because of the significant upfront costs associated with developing these networks, Jeffrey A. Switzer, DO, from Georgia Health Sciences University in Augusta, Ga., and colleagues set out to ascertain cost-effectiveness from the perspective of each component facility.

The researchers developed a decision analytic model using unpublished data from the Georgia Health Sciences University and Mayo Clinic telestroke networks, both of which are single-hub, seven-spoke networks, to determine the cost and outcomes of treating patients with acute ischemic stroke through a network and outside a network. The study looked at rates of teleconsultations with stroke experts, intravenous thrombolysis and endovascular stroke therapies between hospitals when a network is available compared to no network. The researchers also considered spoke-to-hub transfer rates within telestroke networks. Effectiveness was measured by discharge destination (home, nursing home/rehabilitation facility, or in-hospital death), and effectiveness data was estimated based on data derived from published clinical trials.

In a network with 1,112 unique acute ischemic stroke patients per year, the study estimated that 45 patients per year would receive intravenous thrombolysis who would not have received it in the absence of a network, and 20 more patients per year would receive endovascular stroke therapies, resulting in 6.11 more discharges to home in a network than in the absence of a network. Researchers estimated cost savings in the network overall at $358,435 per year for the first year, increasing to $393,712 at the end of the fifth year.

The hub facility bore the brunt of the costs, which researchers estimated at $405,121 per year, while each spoke saved $109,080 per year. The researchers suggested that with appropriate cost-sharing arrangements, over a five-year period all hospitals in the system could save an average of $44,804 per year.

The study revealed that hospital costs were sensitive to transfer rates, with savings to the network as a whole and spoke hospitals diminishing as transfer rates from the spoke hospitals to the hub increased. On the other hand, costs to the hub hospital decreased with increased transfers to the hub. However, the researchers claimed that their model showed a target transfer rate of approximately 30 percent resulted in cost savings to the hub, the spokes, and the network overall.