Lorena Hoffmeister1, Pablo M Lavados2, Javier Mar3, Merce Comas4, Arantzazu Arrospide5, Xavier Castells6. 1. Escuela de Salud Pública, Facultad de Medicina, Universidad Mayor, Santiago, Chile. Electronic address: lorena.hoffmeister@umayor.cl. 2. Unidad de neurología Vascular, servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile. Electronic address: pablolavados@yahoo.com. 3. Unidad de Manejo Clínico, Hospital Alto Deba, Mondragón, País Vasco, Spain. Electronic address: franciscojavier.marmedina@osakidetza.net. 4. Departamento de Epidemiología y Evaluación, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain. Electronic address: mcomas@parcdesalutmar.cat. 5. Unidad de Manejo Clínico, Hospital Alto Deba, Mondragón, País Vasco, Spain. Electronic address: arantzazu.arrospideelgarresta@osakidetza.net. 6. Departamento de Epidemiología y Evaluación, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain. Electronic address: xcastells@parcdesalutmar.cat.
Abstract
BACKGROUND: The only pharmacological treatment with proven cost-effectiveness in reducing acute ischemic stroke (AIS) associated disability is intravenous thrombolysis with recombinant tissue plasminogen activator but it's utilization rate is still low in most of the world. We estimated the minimum thrombolysis utilization rate needed to decrease the prevalence of stroke-related disability at a population level by using a discrete-event simulation model. METHODS: The model included efficacy according to time to treatment up to 4.5h, and four scenarios for the utilization of intravenous thrombolysis in eligible patients with AIS: a) 2%; b) 12% c) 25% and d) 40%. We calculated the prevalence of AIS related disability in each scenario, using population based data. The simulation was performed from 2002 to 2017 using the ARENA software. RESULTS: A 2% utilization rate yielded a prevalence of disability of 359.1 per 100,000. Increasing thrombolysis to 12% avoided 779 disabled patients. If the utilization rate was increased to 25%, 1783 disabled patients would be avoided. The maximum scenario of 40% decreased disability to 335.7 per 100,000, avoiding 17% of AIS-related disability. CONCLUSION: The current utilization rate of intravenous thrombolysis of 2% has minimal population impact. Increasing the rate of utilization to more than 12% is the minimum to have a significant population effect on disability and should be a public policy aim.
BACKGROUND: The only pharmacological treatment with proven cost-effectiveness in reducing acute ischemic stroke (AIS) associated disability is intravenous thrombolysis with recombinant tissue plasminogen activator but it's utilization rate is still low in most of the world. We estimated the minimum thrombolysis utilization rate needed to decrease the prevalence of stroke-related disability at a population level by using a discrete-event simulation model. METHODS: The model included efficacy according to time to treatment up to 4.5h, and four scenarios for the utilization of intravenous thrombolysis in eligible patients with AIS: a) 2%; b) 12% c) 25% and d) 40%. We calculated the prevalence of AIS related disability in each scenario, using population based data. The simulation was performed from 2002 to 2017 using the ARENA software. RESULTS: A 2% utilization rate yielded a prevalence of disability of 359.1 per 100,000. Increasing thrombolysis to 12% avoided 779 disabled patients. If the utilization rate was increased to 25%, 1783 disabled patients would be avoided. The maximum scenario of 40% decreased disability to 335.7 per 100,000, avoiding 17% of AIS-related disability. CONCLUSION: The current utilization rate of intravenous thrombolysis of 2% has minimal population impact. Increasing the rate of utilization to more than 12% is the minimum to have a significant population effect on disability and should be a public policy aim.
Authors: Verónica V Olavarría; Lorena Hoffmeister; Carolina Vidal; Alejandro M Brunser; Arnold Hoppe; Pablo M Lavados Journal: Front Neurol Date: 2022-04-08 Impact factor: 4.086