Effectiveness and Cost-Effectiveness of TeleStroke Consultations to Support the Care of Stroke Patients Presenting to Regional Emergency Departments in Western Australia: An Economic Evaluation Case Study Protocol

Abstract

ABSTRACTIntroductionThe Western Australia Acute TeleStroke Programme commenced incrementally across regional Western Australia (WA) during 2016-2017. Since the introduction of the TeleStroke Programme, there has been monitoring of service outputs including regional patient access to tertiary stroke specialist advice and reperfusion treatment, however, the impact of consultation with a stroke specialist via telehealth (videoconferencing or telephone) on the effectiveness and cost-effectiveness of stroke care, and the drivers of cost-effectiveness has not been systematically evaluated.Methods and AnalysisThe aim of the case study is to examine the impact of consultation with a stroke specialist via telehealth on the effectiveness and cost-effectiveness of stroke and TIA care using a mixed methods approach. A categorical decision tree model will be constructed in collaboration with clinicians and programme managers. A before and after comparison using State-wide administrative datasets will be used to run the base model. If sample size and statistical power permits, the cases and comparators will be matched by stroke type and presence of CT scan at the initial site of presentation, age category and presenting hospital. The drivers of cost-effectiveness will be explored through stakeholder interviews. Data from the qualitative analysis will be cross-referenced with trends emerging from the quantitative dataset and used to guide the factors to be involved in sub-group and sensitivity analysis.Ethics and DisseminationEthics approval for this case study has been granted from the WACHS Human Research and Ethics Committee (RGS3076). Reciprocal approval has been granted from Curtin University Human Research Ethics Office (HRE2019-0740). Findings will be disseminated publicly through conference presentation and peer-review publications. Interim findings will be released as internal reports to inform the service development.Strengths and Limitations of This StudyComparison of the impact of stroke specialist consultation via telehealth in regional Australia in supporting the management of different stroke subtypesThe decision tree model will be constructed in collaboration with clinicians and programme administrators directly involved in the delivery of the TeleStroke ProgrammeUse of local administrative data as model inputs enables the base model to reflect the reality of the regional WA Health service deliveryCollaboration with WA Health stakeholders involved in TeleStroke Programme design and implementation to optimise utility of the case study to inform service development and expansionConversion of the functional outcome modified Rankin Scale score (mRS) to quality adjusted life years (QALY) relies on national or international averages