Eme mergent ent Tel elem emedi edicine cine Co Consul sulta - - PowerPoint PPT Presentation

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Co Cost st Uti tility ity of a N Neuro- Eme mergent ent Tel elem emedi edicine cine Co Consul sulta tation tion Program

Justin Whetten Access to Critical Cerebral Emergency Support Services

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DISCLAIMER

• The project described is supported by Grant Number

1C1CMS331351-01-00 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this document are solely the responsibility of authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of it agencies. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the findings of the independent evaluation contractor.

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Special Thanks to ACCESS Team members

Howard Yonas MD – PI, Mark Moffett PhD - Project Economist and Coinvestigator, Colin Semper MBA HCM CAAMA - Director, Susy Salvo-Wendt - Program Manager, Andrew Hollander PhD MBA PMP - Sr. Program Manager, Debra Banks MSN RN – Clinical Nurse Director, Deirdre Kearney MSN RN – Clinical Nurse Director, Elizabeth Muller RN CNRN – Research Nurse, Mingma Sherpa – Community Engagement, Kevin Smith PhD – Research Information Specialist, Vincent Gatlin – Program Planning Manager, Julianna Montoya – Program Coordinator, Gina Encinias – Project Accountant, Ami Montes – Research Tech, Kristen Broesder – Admin Assistant

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Objectives

• To evaluate the cost utility of Neuro-Emergent

Telemedicine Stroke Consultations in the management

• f acute ischemic stroke from the societal perspective
• Determine patient cost savings and health outcomes
• Explain potential gains to rural area hospitals

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Background

• Stroke – 5th leading cause of death in

U.S. and in New Mexico (NM – IBIS, 2014)

• 80% of all strokes are Acute ischemic

stroke (AIS)

• Less than 2% of rural patients

receive Tissue Plasminogen Activator (tPA)

• 73% - New Mexicans live greater than

80 miles from a level one designated neurological center

• Over 88% of patient transfers are

unnecessary transfers

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Neuro-Emergent Telemedicine Consultation Program

• Allows rural doctors to consult with a neurologist
• Improve patient outcomes
• Reduce unnecessary transfers
• Allows rural hospitals to keep patients

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Question

• What is the cost-effectiveness of a Neuro-Emergent

Telemedicine Consultation Program from the societal perspective?

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Methods

Lifetime Markov model

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Methods

Stroke Tunnel state

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Methods

• Health states based on the modified Rankin scale
• Minimal-to-no disability
• Moderate-to-severe disability
• Death
• Costs
• Initial and recurrent stroke treatment
• Rehabilitation, long-term care, caregiver costs
• Consultation
• Hospital transfer
• Model inputs were obtained from ACCESS supplemented by

current literature

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ACCESS Access to Critical Cerebral Emergency Support Services

• Patients admitted to rural emergency departments
• May 2015 through February 2017
• All neurological and neurosurgical emergent

encounters

• 1300+ individuals

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Transition Probabilities

Transition Access Control Scan < 3 hrs 19.47% 2% Scan > 3 hrs 80.53% 98% transfer 10% 85% don’t transfer 90% 15% tPA 84% 44% No tPA 17% 56%

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Cost Inputs/ QALY`s

QALY Minimal-to-no Disability 0.72 Moderate-to-severe Disability 0.38 Death

Costs Cost of Scan 2,000 $ Cost of Transfer 38,000 $ Cost of mild stroke 14,102 $ Cost of severe stroke 18,856 $ Cost of Consultation 600 $ Cost of Rehabilitation 21,688 $ Cost of Long-term care 77,745 $ Cost of Caregiver 23 $

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Results

Access Non-Access Difference ICER Total Costs 556,651.00 $ 611,576.00 $

• $54,925.00
• 422500

QALY`s 6.17 6.04 0.13 Dominate

• Transfer costs

– Even when transfer costs were set at $0 there was a cost savings per patient of $5500.

• Compared with no network, patients treated in a

telestroke network incurred $54,925 lower costs and gained 0.13 QALYs over a lifetime.

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Conclusions

• Gain of 0.13 QALY
• Cost savings of $54,925 per patient
• $54,925,000 per 100
• Transfers dropped from 85% to 10%
• tPA administration increased from under 2% to
• ver 16%
• Referring hospitals gained about 3.4 million per

100 patients that used ACCESS program

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DISCLAIMER

• The project described is supported by Grant Number

1C1CMS331351-01-00 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this document are solely the responsibility of authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of it agencies. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the findings of the independent evaluation contractor.