Regional and national differences in stroke thrombolysis use and disparities in pricing, treatment availability, and coverage

de Souza AC 1 , Sebastian IA 2 , Zaidi WAW 3 , Nasreldein A 4 , Bazadona D 5 , Amaya P 6 Show all authors , Elkady A 7 , Gebrewold MA 8 , Vorasayan P 9 , Yeghiazaryan N 10 , Michel P 11 , Khatri P 12 , Pandian JD 13 , Martins SCO 14 , Hacke W 15 , Lioutas VA 16

Affiliations 

  • 1 Department of Neurology, Hospital Moinhos de Vento, Porto Alegre, Brazil
  • 2 Department of Neurology, St. Stephen's Hospital, Delhi, India
  • 3 Medical Department, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
  • 4 Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt
  • 5 Department of Neurology, University Hospital Centre Zagreb, Zagreb, Croatia
  • 6 Department of Neurology, Stroke Program, Fundación Valle del Lili, Cali, Colombia
  • 7 Department of Neurology, Saudi German Hospital Jeddah, Jeddah, Saudi Arabia
  • 8 Department of Neurology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
  • 9 Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • 10 Department of Neurology, Stroke Unit, Erebouni Medical Center, Yerevan, Armenia
  • 11 Stroke Center, Neurology Service, Department of Clinical Neuroscience, Lausanne University Hospital, Lausanne, Switzerland
  • 12 Vascular Neurology Division, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
  • 13 Department of Neurology, Christian Medical College, Ludhiana, India
  • 14 Department of Neurology, Hospital Moinhos de Vento and Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
  • 15 University of Heidelberg, Heidelberg, Germany
  • 16 Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Int J Stroke, 2022 10;17(9):990-996.
PMID: 35137645 DOI: 10.1177/17474930221082446

Abstract

BACKGROUND: Major disparities have been reported in recombinant tissue plasminogen activator (rtPA) availability among countries of different socioeconomic status.

AIMS: To characterize variability of rtPA price, its availability, and its association with and impact on each country's health expenditure (HE) resources.

METHODS: We conducted a global survey to obtain information on rtPA price (50 mg vial, 2020 US Dollars) and availability. Country-specific data, including low, lower middle (LMIC), upper middle (UMIC), and high-income country (HIC) classifications, and gross domestic product (GDP) and HE, both nominally and adjusted for purchasing power parity (PPP), were obtained from World Bank Open Data. To assess the impact of rtPA cost, we computed the rtPA price as percentage of per capita GDP and HE and examined its association with the country income classification.

RESULTS: rtPA is approved and available in 109 countries. We received surveys from 59 countries: 27 (46%) HIC, 20 (34%) UMIC, and 12 (20%) LMIC. Although HIC have significantly higher per capita GDP and HE compared to UMIC and LMIC (p < 0.0001), the median price of rtPA is non-significantly higher in LMICs (USD 755, interquartile range, IQR (575-1300)) compared to UMICs (USD 544, IQR (400-815)) and HICs (USD 600, IQR (526-1000)). In LMIC, rtPA cost accounts for 217.4% (IQR, 27.1-340.6%) of PPP-adjusted per capita HE, compared to 17.6% (IQR (11.2-28.7%), p < 0.0001) for HICs.

CONCLUSION: We documented significant variability in rtPA availability and price among countries. Relative costs are higher in lower income countries, exceeding the available HE. Concerted efforts to improve rtPA affordability in low-income settings are necessary.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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