Gongora-Rivera Fernando, Gonzalez-Aquines Alejandro, Marquez-Romero Juan Manuel
Department of Neurology, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
Department of Neurology, Instituto Mexicano del Seguro Social (IMSS) HGZ 2, Aguascalientes, Mexico.
Front Neurol. 2021 Feb 9;12:601328. doi: 10.3389/fneur.2021.601328. eCollection 2021.
Providing endovascular treatment (EVT) access for acute ischemic stroke (AIS) is a challenge in Latin America. Even though the Mexican Endovascular Reperfusion Registry (MERR) and the RESILIENT trial have demonstrated the feasibility of EVT of AIS in Latin America, the MERR has uncovered potential challenges to delivering EVT to AIS patients. To identify the perceived barriers to access EVT for AIS in Mexico. We surveyed endovascular neurologists in Mexico. The survey addressed the situation of thrombectomy in the country and the infrastructure and resources available in the participants' institutions. The questionnaire inquired about costs, barriers, and challenges to accessing EVT for AIS, emphasizing the prices and availability of medical devices needed for EVT. We analyzed data from 21 hospitals. The most extreme identified barriers to access EVT were the lack of health coverage for EVT in the National Health System, the cost of the medical supplies for EVT, and inadequate knowledge of stroke symptoms in the general population. The median cost for EVT was USD 20,000 (IQR 7,500-20,000). From this amount, 60% (IQR 50-70%) corresponded to the costs involved with medical devices. EVT carried additional out-of-pocket costs in 90% of the hospitals, and in 57%, the costs exceed USD $10,000. Efforts at all government levels and society are required to tackle these barriers. An increase in and efficient use of public funding for EVT coverage and the deployment of continuous and targeted stroke education campaigns could reduce inequities in EVT access in Mexico.
在拉丁美洲，为急性缺血性卒中（AIS）提供血管内治疗（EVT）通路是一项挑战。尽管墨西哥血管内再灌注登记系统（MERR）和RESILIENT试验已证明在拉丁美洲对AIS进行EVT的可行性，但MERR发现了为AIS患者提供EVT存在的潜在挑战。为了确定墨西哥在获取AIS的EVT方面所感知到的障碍。我们对墨西哥的血管内神经科医生进行了调查。该调查涉及该国血栓切除术的情况以及参与者所在机构可用的基础设施和资源。问卷询问了获取AIS的EVT的成本、障碍和挑战，重点是EVT所需医疗设备的价格和可及性。我们分析了来自21家医院的数据。确定的获取EVT最极端的障碍是国家卫生系统中缺乏EVT的医保覆盖、EVT医疗用品的成本以及普通人群对卒中症状的认识不足。EVT的中位成本为20,000美元（四分位间距7,500 - 20,000美元）。在这个金额中，60%（四分位间距50 - ）对应于医疗设备的成本。在90%的医院中，EVT还带来了额外的自付费用，在57%的医院中，这些费用超过10,000美元。各级政府和社会都需要努力应对这些障碍。增加并有效利用公共资金用于EVT覆盖，并开展持续且有针对性的卒中教育活动，可以减少墨西哥在获取EVT方面的不平等现象。
