Authors: René Handschu Mateusz Scibor Martin Nückel Dirk Asshoff Barbara Willaczek Frank Erbguth Stefan Schwab Frank Daumann
Publish Date: 2014/08/01
Volume: 261, Issue: 10, Pages: 2003-2008
Abstract
Telemedicine is in increasing use in clinical neuroscience such as acute stroke care especially by applying remote audiovisual communication for patient evaluation However telephone consultation was also used linking stroke centres to smaller hospitals We compared costs of telestroke services using audiovisual and telephone communication in different organizational models Within a small network in Northern Bavaria videobased teleconsultation VTC and telephone advice TA was provided for evaluation of acute stroke patients on a weekly rotation The costs of the admissions process with or without one of both methods of telemedicine were calculated and compared from the perspective of the spoke hospital Different levels of service and network size were modelled and costs of transfers as well as loss of revenues were calculated Yearly total labour costs were 415000 € for an onsite service VTCservice compared to 61000 € in an oncall service Additional costs for one teleconsultation were 10955 € in VTC and 4982 € in TA VTC/TA ratio 22 The ratio decreased to 08 when accounting for costs of transfer and loss of reimbursement for all patients transferred as transfer of patients to the stroke centre was more frequent after TA 91 vs 149 fulltime onsite ser Costs of one QALY gained by using VTC instead of TA ranged from 11500 € to 51586 € depending on the different models In the first view TA looks like the less expensive method as it is easy to access and works without additional costs When accounting for all disadvantages TA becomes slightly more expensive In telestroke care VTC should be recommended as the method of choice also from an economic perspectiveWe are very grateful to Mrs Andrea Handschu MSc who reviewed all calculations and accountings in this manuscript and to Mrs Sonja Heinloth for editing the manuscript The STENOproject was supported by a public grant of the Bavarian State Ministry of Health and Social Welfare
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