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

de Souza AC, Sebastian IA, Zaidi WAW, Nasreldein A, Bazadona D, Amaya P, et al.

Int J Stroke, 2022 10;17(9):990-996.
PMID: 35137645 DOI: 10.1177/17474930221082446

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.
Standards of Practice in Acute Ischemic Stroke Intervention International Recommendations

Pierot L, Jarayaman M, Szikora I, Hirsch J, Baxter B, Miyachi S, et al.

Can J Neurol Sci, 2019 05;46(3):269-274.
PMID: 30890199 DOI: 10.1017/cjn.2019.1

After five positive randomized controlled trials showed benefit of mechanical thrombectomy in the management of acute ischemic stroke with emergent large-vessel occlusion, a multi-society meeting was organized during the 17th Congress of the World Federation of Interventional and Therapeutic Neuroradiology in October 2017 in Budapest, Hungary. This multi-society meeting was dedicated to establish standards of practice in acute ischemic stroke intervention aiming for a consensus on the minimum requirements for centers providing such treatment. In an ideal situation, all patients would be treated at a center offering a full spectrum of neuroendovascular care (a level 1 center). However, for geographical reasons, some patients are unable to reach such a center in a reasonable period of time. With this in mind, the group paid special attention to define recommendations on the prerequisites of organizing stroke centers providing medical thrombectomy for acute ischemic stroke, but not for other neurovascular diseases (level 2 centers). Finally, some centers will have a stroke unit and offer intravenous thrombolysis, but not any endovascular stroke therapy (level 3 centers). Together, these level 1, 2, and 3 centers form a complete stroke system of care. The multi-society group provides recommendations and a framework for the development of medical thrombectomy services worldwide.
Standards of Practice in Acute Ischemic Stroke Intervention: International Recommendations

Pierot L, Jayaraman MV, Szikora I, Hirsch JA, Baxter B, Miyachi S, et al.

AJNR Am J Neuroradiol, 2018 11;39(11):E112-E117.
PMID: 30442688 DOI: 10.3174/ajnr.A5853

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