J Med Assoc Thai 2018; 101 (7):875-81

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Trend in Recombinant Tissue Plasminogen Activator (rtPA) Use for Ischemic Stroke in Thailand: Geographic Inequality, Cost of Treatment and Impact on 30-Day Case Fatality Rate
Vongmongkol V , Tangcharoensthien V , Greetong T , Mcneil E , Chongsuvivatwong V Mail

Objective: To investigate trend of using thrombolysis in ischemic stroke patient under Universal Health Coverage Scheme from fiscal year 2011 to 2014 and explore cost of treatment and the effect of rtPA use on clinical outcome among patient who received and did not received rtPA.

Materials and Methods: The present analysis used 3 datasets comprised of the inpatient database of the Universal Health Coverage (UC) from the National Health Security Office, operating cost of hospitals from division of the Health Insurance, Ministry of Public Health and the Civil Registration Database from the Ministry of Interior. Patients with ischemic stroke in fiscal year 2011 to 2014 were retrieved based on the ICD10 code of I63. The 30-day case fatality was identified by using the date of death from the Civil Registration Database. Logistic regression was performed to compare 30-day case fatality between patient who received and did not receive rtPA with adjusted by sex, age, Charlson comorbidity index and year of admission.

Results: The rate of thrombolytic treatment has increased from 1.6% in 2011 to 3.8% in 2013. The percentage of rtPA treatment among male and female did not differ. The patients treated with rtPA were slight younger age, while Charlson comorbidity index did not differ. The geographical inequality of rtPA treatment gradually declined over time. Cost of treatment in rtPA usage was 4 times higher than without rtPA. The patients treated with rtPA had an increasing 30-day case fatality rate of 11% (OR 1.11, 95% CI 1.03-1.21) compared to those without rtPA after adjustment for other variables.

Conclusion: The rate of using rtPA in the Universal Health Coverage Scheme has been increasing during the present study period but remained low. More detail data collection are needed in the future to evaluate the benefit of rtPA use in Thailand.

Keywords: Ischemic stroke, Thrombolysis rate, Recombinant tissue plasminogen activator, Cost of treatment

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