We plan to study at 2 Mayo Sites involved in C3FIT, Arizona and Florida, the incremental cost effectiveness ratio (ICER) of the two arms.  We hypothesize the telemedicine arm of the trial will cost-effective compared to standard in person physician visits arm of the trial by one year.

C3FIT is a randomized stroke trial funded by PCORI aimed at assessing the comparative effectiveness of two patient-centric outcomes at certified Comprehensive and Primary Stroke Centers (CSC/PSC) - existing stroke care model compared to telemedicine-enabled, integrated care delivery model called an Integrated Stroke Practice Unit (ISPU).

C3FIT is a  randomized trial of 18 CSC/PSC-certified Clinical Sites including Mayo Clinic at Arizona and Florida, stratified by patient volume and  randomized to management using the CSC/PSC or ISPU Model. The primary outcomes (Stroke Impact Scale 3.0 (SIS) and Modified Rankin Scale (mRS)) will be centrally assessed by Statistical and Data Coordinating Center (SDCC) staff blinded to treatment assignment (PROBE design) at 3, 6, 12 and 24 months; with  primary assessment being an “efficacy” outcome at 12 months assessment,  secondary outcomes including the “durability” assessment at 24 months after treatment, secondary indices of stroke outcome and  assessment of treatment effect modification by demographic  and Socioeconomic status. To calculate  ICER equation 2 costs and 2 outcomes will be used, Stroke impact Scale (SIS, v3.0) will be used for the two outcome measures and costs will compare LOS (length of stay as surrogates for hospitalization based on average costs.  We also may compare TDABC (Time Driven Activity Based Costing) map costs for the two arms in substitution for the ICER equation.

We hypothesize that telemedicine-enabled post-stroke discharge care will be cost-effective in the future C3FIT trial and if proven to be cost-effective, with scalable effects for rural US stroke health care and  underdeveloped countries stroke care.