Mechanical thrombectomy, considered the most modern and effective treatment for the acute phase of ischemic stroke, could save the lives of many patients in Poland. However, the pilot program for the implementation of this procedure has not lived up to its name, delaying widespread access to this treatment method, according to the NIK.
Mechanical thrombectomy - an untapped opportunity for stroke patients
Published Sept. 12, 2024 10:50
fot. Materiał urzędowy Najwyższej Izby Kontroli
The purpose of the pilot study of the treatment of the acute phase of ischemic stroke with mechanical thrombectomy was to test the organizational model for treating strokes with this method in medical entities. It was also intended to provide a basis for the decision to include mechanical thrombectomy in the basket of guaranteed benefits. Despite achieving the program's goals already in 2021-2022, the Health Minister extended its implementation until mid-2024. This was tantamount to limiting the availability of this procedure, as a limited number of medical centers participated in the test version of the program. Annually, only 4.5% of ischemic stroke patients underwent mechanical thrombectomy. It is estimated that once this procedure is included in the catalog of guaranteed services, its availability to patients would increase to 7-10%.
Mechanical thrombectomy - the most effective method of stroke treatment
About 80,000 stroke patients are hospitalized in Poland each year, 87% of which are ischemic strokes. The total cost of treating patients hospitalized for stroke in 2018-2022 exceeded PLN 4 billion. Stroke is the second most common cause of death or disability worldwide. Studies show that mechanical thrombectomy of intracerebral or intracranial vessels, which involves the mechanical removal of a clot from the brain and restoration of blood circulation, is the most effective treatment for the acute phase of ischemic stroke. This procedure is especially recommended for patients with the worst prognosis for survival and quality of life.
Experts recommend performing mechanical thrombectomy in specialized centers - comprehensive stroke centers. These facilities must provide comprehensive care, including state-of-the-art vascular surgery and access to highly specialized diagnostic equipment. Qualified specialists and round-the-clock care in intensive care units are also important.
Problems with the implementation of the pilot program
The pilot was to run from December 1, 2018 to November 30, 2020, and included seven medical centers. During the implementation of the program, the number of centers was increased to 29, and the cost of the program increased from the planned PLN 85.3 million to PLN 371.7 million, or about 336%.
According to the NIK, prolonging the program and increasing the number of centers was only aimed at delaying the decision to include mechanical thrombectomy in the guaranteed benefits, which limited the availability of this procedure for patients.
Unequal treatment of medical centers
The audit found that the Health Minister did not treat all treatment centers participating in the program equally, as well as those that applied to be included in the list of implementers. Some centers, despite their claimed experience and meeting the requirements, were not included, while others that did not meet the requirements were admitted to the program. An example is a center from the province of Opole, which was admitted to the program despite its lack of experience in performing mechanical thrombectomy procedures.
During the course of the program, three centers reported high mortality rates for patients undergoing mechanical thrombectomy procedures. The Minister of Health ordered provincial consultants to evaluate the medical management in only two cases, omitting the evaluation of the third center. The NIK found this unacceptable, pointing out the need to conduct a detailed analysis in each case of high mortality and take corrective action.
Conclusions and recommendations of the NIK
The Supreme Audit Institution recommended that the Health Minister transform pilot programs into test programs, allowing for quick assessments of effects. The National Health Service was ordered to monitor implementers' compliance with contracts for pilot programs.
The Minister of Health issued a decree in June 2024 that added the mechanical thrombectomy procedure to the list of guaranteed services. However, this delay has cost many patients the chance for a faster recovery.
Source: NIK
