Abstract TP165: Cost-Effectiveness of Telestroke in Acute Ischemic Stroke: A Systematic Review and Incremental Net Benefit Analysis

Introduction: Stroke is a leading cause of disability and mortality worldwide, with a high economic burden. Timely access to treatments such as thrombolysis is essential; however, geographic and workforce disparities limit equitable care. Tele-stroke programs aim to address these gaps, yet controversies remain regarding their cost-effectiveness and cost-utility. Objective: To assess the cost-effectiveness and cost-utility of tele-stroke programs Design/Methods: A systematic review was conducted following PRISMA guidelines. PubMed, Scopus, Web of Science, Cochrane Library, and CENTRAL were searched for studies published up to August 2025. Eligible studies evaluated the economic impact of telestroke interventions in adults with acute ischemic stroke using cost-benefit, cost-effectiveness, or cost-utility frameworks. Data were extracted on costs, health outcomes (QALYs), and incremental cost-effectiveness ratios (ICERs). Where possible, incremental net benefit (INB) was calculated using a willingness-to-pay (WTP) threshold of $50,000 per QALY. Costs reported in local currencies were converted to 2024 USD. Results: From 2,572 articles screened, 15 studies published between 2008 and 2023 were included: 1 cost–benefit, 11 cost-effectiveness, and 3 cost-utility analyses. Short-term analyses (<1 year) were inconsistent: telestroke was not cost-effective in most 90-day and 1-year evaluations. At 2 years, telestroke was cost-effective and dominant. Lifetime horizons consistently demonstrated strong cost-effectiveness, with INBs ranging from +$3,073 to +$106,464, including several dominant strategies (cost-saving with higher QALYs). Conclusions: Telestroke interventions demonstrate variable cost-effectiveness in the short term but appear consistently cost-effective and often dominant over a lifetime horizon.