Skip to main content
Log in

National Use of Thrombolysis with Alteplase for Acute Ischaemic Stroke via Telemedicine in Denmark

A Model of Budgetary Impact and Cost Effectiveness

  • Original Research Article
  • Published:
CNS Drugs Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Table I
Table II
Table III
Table IV

Similar content being viewed by others

Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

References

  1. Hacke W, Donnan G, Fieschi C, et al. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. ATLANTIS Trials Investigators, ECASS Trials Investigators, NINDS rt-PA Study Group Investigators. Lancet 2004; 363: 768–74

    Article  PubMed  Google Scholar 

  2. Fagan SC, Morgenstern LB, Petitta A, et al. Cost-effectiveness of tissue plasminogen activator for acute ischemic stroke. NINDS rt-PA Stroke Study Group. Neurology 1998; 50: 883–90

    Article  PubMed  CAS  Google Scholar 

  3. Sinclair S, Frighetto L, Loewen P, et al. Cost-utility analysis of tissue plasminogen activator therapy for acute ischaemic stroke: a Canadian healthcare perspective. Pharmacoeconomics 2001; 19(9): 927–36

    Article  PubMed  CAS  Google Scholar 

  4. Sandercock P, Berge E, Dennis M, et al. A systematic review of the effectiveness, cost-effectiveness and barriers to implementation of thrombolytic and neuroprotective therapy for acute ischaemic stroke in the NHS. Health Technol Assess 2002; 6(26): 1–112

    PubMed  CAS  Google Scholar 

  5. Sandercock P, Berge E, Dennis M, et al. Cost-effectiveness of thrombolysis with recombinant tissue plasminogen activator for acute ischemic stroke assessed by a model based on UK NHS costs. Stroke 2004; 35: 1490–8

    Article  PubMed  Google Scholar 

  6. Mar J, Begiristain JM, Arrazola A. Cost-effectiveness analysis of thrombolytic treatment for stroke. Cerebrovasc Dis 2005; 20: 193–200

    Article  PubMed  Google Scholar 

  7. Ehlers L, Andersen G, Clausen LB, et al. Cost-effectiveness of intravenous thrombolysis with alteplase within a 3-hour window after acute ischemie stroke. Stroke 2007; 38(1): 85–9

    Article  PubMed  CAS  Google Scholar 

  8. Demaerschalk BM, Yip TR. Economic benefit of increasing utilization of intravenous tissue plasminogen activator for acute ischemic stroke in the United States. Stroke 2005; 36: 2500–3

    Article  PubMed  Google Scholar 

  9. Bech M, Ehlers L, Andersen G, et al. HTA of thrombolytic therapy in patients with acute ischemic stroke [in Danish]. Aarhus: HTA Unit, Aarhus University Hospital, Department of Public Health, 2005

    Google Scholar 

  10. Audebert HJ, Kukla C, von Claranau SC, et al. Telemedicine for safe and extended use of thrombolysis in stroke: the telemedic pilot project for integrative stroke care (TEMPis) in Bavaria. Stroke 2005; 36: 287–91

    Article  PubMed  CAS  Google Scholar 

  11. Dubinsky R, Lai SM. Mortality of stroke patients treated with thrombolysis: analysis of nationwide inpatient sample. Neurology 2006; 66: 1742–4

    Article  PubMed  Google Scholar 

  12. Davis S, Lees K, Donnan G. Treating the acute stroke patient as an emergency: current practices and future opportunities. Int J Clin Pract 2006; 60: 399–407

    Article  PubMed  CAS  Google Scholar 

  13. Solomon NA, Glick HA, Russo CJ, et al. Patient preferences for stroke outcomes. Stroke 1994; 25: 1721–5

    Article  PubMed  CAS  Google Scholar 

  14. Köhrmann M, Jüttler E, Fiebach JB, et al. MRI versus CT-based thrombolysis treatment within and beyond the 3-hour time window after stroke onset: a cohort study. Lancet Neurol 2006; 5: 661–7

    Article  PubMed  Google Scholar 

  15. Porsdal V, Boysen G. Direct costs of transient ischemic attacks: a hospital-based study of resource use during the first year after transient ischemic attacks in Denmark. Stroke 1998; 29: 2321–4

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

This study has been funded by The Danish Heart Foundation and the Aarhus University Hospital, Aarhus, Denmark. The authors have no conflicts of interest that are directly relevant to the content of this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lars Ehlers.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ehlers, L., Müskens, W.M., Jensen, L.G. et al. National Use of Thrombolysis with Alteplase for Acute Ischaemic Stroke via Telemedicine in Denmark. CNS Drugs 22, 73–81 (2008). https://doi.org/10.2165/00023210-200822010-00006

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00023210-200822010-00006

Keywords

Navigation