@Article{info:doi/10.2196/mhealth.8288,
author="Valenzuela Espinoza, Alexis
and Devos, Stefanie
and van Hooff, Robbert-Jan
and Fobelets, Maaike
and Dupont, Alain
and Moens, Maarten
and Hubloue, Ives
and Lauwaert, Door
and Cornu, Pieter
and Brouns, Raf
and Putman, Koen",
title="Time Gain Needed for In-Ambulance Telemedicine: Cost-Utility Model",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Nov",
day="24",
volume="5",
number="11",
pages="e175",
keywords="telemedicine; prehospital; stroke; cost effectiveness",
abstract="Background: Stroke is a very time-sensitive pathology, and many new solutions target the optimization of prehospital stroke care to improve the stroke management process. In-ambulance telemedicine, defined by live bidirectional audio-video between a patient and a neurologist in a moving ambulance and the automated transfer of vital parameters, is a promising new approach to speed up and improve the quality of acute stroke care. Currently, no evidence exists on the cost effectiveness of in-ambulance telemedicine. Objective: We aim to develop a first cost effectiveness model for in-ambulance telemedicine and use this model to estimate the time savings needed before in-ambulance telemedicine becomes cost effective. Methods: Current standard stroke care is compared with current standard stroke care supplemented with in-ambulance telemedicine using a cost-utility model measuring costs and quality-adjusted life-years (QALYs) from a health care perspective. We combine a decision tree with a Markov model. Data from the UZ Brussel Stroke Registry (2282 stroke patients) and linked hospital claims data at individual level are combined with literature data to populate the model. A 2-way sensitivity analysis varying both implementation costs and time gain is performed to map the different cost-effective combinations and identify the time gain needed for cost effectiveness and dominance. For several modeled time gains, the cost-effectiveness acceptability curve is calculated and mapped in 1 figure. Results: Under the base-case scenario (implementation cost of US {\$}159,425) and taking a lifetime horizon into account, in-ambulance telemedicine is a cost-effective strategy compared to standard stroke care alone starting from a time gain of 6 minutes. After 12 minutes, in-ambulance telemedicine becomes dominant, and this results in a mean decrease of costs by US --{\$}30 (95{\%} CI --{\$}32 to --{\$}29) per patient with 0.00456 (95{\%} CI 0.00448 to 0.00463) QALYs on average gained per patient. In over 82{\%} of all probabilistic simulations, in-ambulance telemedicine remains under the cost-effectiveness threshold of US {\$}47,747. Conclusions: Our model suggests that in-ambulance telemedicine can be cost effective starting from a time gain of 6 minutes and becomes a dominant strategy after approximately 15 minutes. This indicates that in-ambulance telemedicine has the potential to become a cost-effective intervention assuming time gains in clinical implementations are realized in the future. ",
issn="2291-5222",
doi="10.2196/mhealth.8288",
url="http://mhealth.jmir.org/2017/11/e175/",
url="https://doi.org/10.2196/mhealth.8288",
url="http://www.ncbi.nlm.nih.gov/pubmed/29175808"
}