Abstract WP102: Impact of National Universal Health Coverage on Access to Mechanical Thrombectomy: A Sub-Analysis of the Mechanical Thrombectomy Global Access for Stroke (MT Glass)- A Mission Thrombectomy Study

Abstract

Background: The WHO’s third Sustainable Development Goal (SDG Target 3.8) identifies Universal health coverage (UHC) as a target for countries to attain by 2030. The availability of UHC is intricately linked to access to emergency healthcare without incurring financial hardship. The MT-GLASS study demonstrated that access to mechanical thrombectomy (MT) on a global level is minuscule, with enormous disparities between countries. We aim to study the impact of national UHC on access to MT. Methods: The MT-GLASS survey was conducted in 75 countries through the Mission Thrombectomy 2020+ (MT2020+) global professional peer volunteer network. The primary endpoints were the current annual Mechanical Thrombectomy Access (MTA), MT operator availability, and MT center availability in the country. MTA was defined as the estimated proportion of patients with LVO receiving MT annually. The availability metrics were defined as ([current MT operatorsх50/current annual number of estimated thrombectomy-eligible LVOs]х100 = MT operator availability) and ([current MT centersх150/current annual number of estimated thrombectomy-eligible LVOs]х100= MT center availability). The metrics used an optimal MT volume per operator of 50 and an optimal MT volume per center of 150. UHC was measured using the service coverage index (SCI: ranges 1-100- per WHO). Results: Of the 59 countries with complete data, the median SCI was 72 (61-78) [Figure-1A- Countries in SCI groups]. Countries with SCI <72 have significantly lower MT access rates, MT center and operator availability, reimbursement facilities, and healthcare spending by GDP (Table in Figure-1B). On multivariable regression analyses, SCI is an independent predictor of MT access [OR-4.5 (1.2-8.2) p=0.02]. Conclusions: National universal health coverage is a significant predictor of access to mechanical thrombectomy for LVO stroke patients.