mt2020 global executive committee (gec) meeting 2020...dileep r. yavagal, md welcome! #mt2020...
TRANSCRIPT
MT2020 Global Executive Committee (GEC) meeting 2020
Stroke policies are local, best practices are global
MT2020 GEC Meeting, Los Angeles, CA. Feb 18th, 2020
Dileep R. Yavagal, MD
Welcome!
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Housekeeping Items
GoTo Meeting callers are muted for the duration of the meeting—Please utilize the chat function
There are microphones at each of the tables, please utilize these when speaking
Mission Thrombectomy 2020
(MT 2020) Global Alliance:
Rapidly Accelerating Global Access
to Stroke Thrombectomy
Dileep R. Yavagal, MD, FSVIN, FAHA, FAANChair, MT2020
On Behalf of the MT 2020 Leadership and Global Executive Committees
MT2020 GEC Meeting, Los Angeles, CA. Feb 18th, 2020
Disclosures
1. Consultant (Modest): Medtronic, Neuralanalytics, Cerenovus, Poseydon, Neurosave
2. Steering Committee member:TIGER,SWIFT Prime, RECOVER-Stroke , MR RESCUE ( Investigator Steering committee)
3. Supported by grants from:Applebaum FoundationFlorida Biomedical CTSI (NIH)Anderson Family Gift
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MT 2020: Funding
2019 Funding
Unrestricted Grants:Gold Level
• Penumbra• Cerenovus• Microvention• Medtronic
Silver Level• IschemiaView
2018 FundingUnrestricted Grants:
Gold Level• Microvention
Silver Level• Penumbra• SVIN
2016-17 Funding• Neuralanalytics• SVIN
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MT 2020 Global Alliance: Partnerships
Partner Organizations1. American Stroke
Association/American Heart Association (ASA/AHA)
2. European Stroke Association (ESO): ResQ Registry
3. Middle East North Africa –Society (MENA-SINO)
4. World Stroke Organization (WSO)
5. SNIS6. WFITN
Endorsing Organizations1. Australian and New Zealand
Assn of Neurologists 2. Calgary Stroke Program (5T
Stroke)3. Italian Society for Study of
Stroke (SISS)4. Kazakhstan National Assn. of
Neurologists Neuroscience (KNANN)
5. Neurocritical Care Society (NCS)6. Neurovascular Exchange (NVX)7. SNVI: Society for Neurovascular
Intervention (India)
SVIN: MT2020 Global Alliance
Global Burden of Stroke: Now Substantially Reversible!
What is a Public Health Intervention (PHI):
• PHIs are measures applied to a population that have certain common characteristics, and can be directed to systems, communities, or individuals.
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When does a treatment need Public Health Intervention (PHI)
• For a treatment to be considered in need of a public health intervention, some criteria must be met: 1) large health burden, getting larger 2) burden distributed unfairly (i.e., certain segments of the population have unequal access)3) There is a highly effective and safe treatment for the condition4) The treatment is cost-effective.5) there must be evidence that upstream preventive strategies could substantially increase access to the effective treatment; and 6) such strategies are not yet in place
Mechanical Thrombectomy is highly Costly but Cost-Effective
• Health-economic analysis• Quantify the impact of
developing stroke care in the country
• Estimates the impact of
gradually increasing uptake
of more effective treatments
over 10 years
• estimated cost savings of
$602 million over 15 years
($255 million direct costs,
$348 million indirect costs).
Upstream PHI Strategies to increase treatment access:
• upstream strategies:
strategies that target
– economic, political, and community factors
• that could substantially increase access to the treatment
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PHI Wheel
• PHI Wheel
– how public health improves population health
– through 17 interventions with communities, the individuals and families that comprise communities, and the systems that impact the health of communities.
PHI 17 Interventions
Barriers to Thrombectomy Access
• Information and Diagnostic Access– availability of information about LVO and triage,
• to specialists; general and emergency care physicians; health care professionals (EMT, nurses); hospitals; clinics; insurance firms; policy-makers; and, patients.
• Physical Access– ability to access Mechanical Thrombectomy procedure for LVO
• distance to facilities; availability of specialty/expertise in the local area; availability of equipment/devices; and, driven by increased volume of patients (through protocols).
• Financial Access– insurance (private or public); ability to pay for MT; speed of
access to payment; and, payment lag (before/at service/after service).
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PHI Strategies
Problem Barrier Enabler System Level Change
Research Needed
EMS LVO triage EMS recognition of LVO triage
FAST-ED education
EMS regulator mandate for bi-annual certification
EMS Quality Metrics data over time.
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How Do Treatments Diffuse?Everett Rodgers Model
18Access is constrained by information, facilities and physicians and financial access. Will there be enough specialists for early majority and late majority stages. How will the association control growth and be relevant?
Nu
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Time and Increase in Access (percentage of population)
Area Under Graph Shows Percentage of Population with Access
Developed Country Access
0.00
2.00
4.00
6.00
8.00
10.00
Acc
ess
Sco
re
Time
Developed Countries Normal Developed Countries MT2020
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MT2020
MT 2020: Current US & World MT Procedure Estimates
• US Device Industry estimates– 2015: 10,000– 2016: 20,000– 2017: 32,000– 2018: 45,000– 2020:? 70,000-80,000
• Worldwide Device Industry estimates– 2016: 79,000
• 22k US, 27k Europe, 30k Asia, Australia
– 2017: 106,000• 32k US , 30k Europe, 43k: Asia,
Australia
– 2018: 156,000– 2019: Projected 198,000
– 2020: Goal 2020,000
• MT total numbers tracking by “triangulation” method– Sales– Independent research
organizations– Public Hospital and Procedure
Statistic Databases
MT 2020 GA Overall Approach: Regional MT Access Scoring based Public Health
InterventionsMT Access Score: 3 Pillars (IPF) with
0-10 score1. Information and Diagnostic Access
– availability of information about LVO and triage, • to specialists; general and emergency care
physicians; health care professionals (EMT, nurses); hospitals; clinics; insurance firms; policy-makers; and, patients.
2. Physical Access– ability to access Mechanical Thrombectomy
procedure for LVO • distance to facilities; availability of
specialty/expertise in the local area; availability of equipment/devices; and, driven by increased volume of patients (through protocols).
3. Financial Access– insurance (private or public); ability to pay for MT;
speed of access to payment; and, payment lag (before/at service/after service).
MT Access Interventions: IPF Interventions
1. Accelerate LVO Diagnosis and Treatment Information & Awareness
2. Accelerate Physical Infrastructure for MT
3. Accelerate Financial Ecosystem for LVO MT treatment
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MT2020 : 2019 PHI#1 Global Intervention—
White Paper for Health Policy Makers :• Objective :
– Develop a White Paper that provides policy-makers with data on LVOs and why a global/national/regional and local strategy to increase Mechanical Thrombectomy is needed. There will be three versions of the report for High-Income, Low-Income and Very Low-Income Countries.
• White Paper :“Building Stroke Thrombectomy Systems of Care In Your Region: Why & How “
– Executive Summary– Strokes and Mission Thrombectomy
• The Basics of LVO• The Context of the Problem• Delivery of Mechanical Thrombectomy
– The Health Economics of Treating LVOs• Cost of Non-treatment—Compare to the Cost of Treatment
– Goals and Objectives for Global/National/Regional and Local governmental and other institutions.
– Proposed Strategies– Conclusion
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MT2020 : 2019 #2. Global Intervention—
• OBJECTIVE– Develop strategies to increase Mechanical
Thrombectomies in High-Income, Low-Income and Very Low-Income Countries. The focus will be on information, training,
1. Patient Journey Educational Materials: (HI,LI, VLI Countries) – Develop a Patient Journey (will aid policymakers and
infrastructure development). – SVIN will develop the new model.
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MT2020 : 2019 #3 Global Intervention—Increase Infrastructure and
Payment (LI, VLI countries)
i. International Thrombectomy Stroke Certification Programs: SNVI-SVIN Self Attestation TSC Certification
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MT2020 : 2020 Interventions In Planning
1. White Paper in Collaboration with SNIS:1. Rural Access to Stroke Thrombectomy in the US
2. White paper in collaboration with WFITN:1. Global Demand for Mechanical Thrombectomy and
Supply
3. Develop Innovative MT Payment Methods for Low-Income Countries and Very Low-Income Countries.
4. Formation of the MT2020 Nursing Subcommittee5. MT2020 Twitter Campaign ( Dr. Clinton Wright, MD):
#I got a stroke, # I got a mechanical thrombectomy6. Connect with WHO on MT2020
MT2020 Website Launched (Dr. Aroor): World Stroke Day, October 29th, 2019
https://missionthrombectomy2020.org/
MT2020 FB Page
MT 2020: Conclusions
1. MT 2020 is a global multi-stakeholder public health campaign to accelerate thrombectomy access for LVO stroke patients with the ultimate goal to lower the death and disability from acute ischemic stroke worldwide
2. The campaign hopes to see a goal of >2020,00MT in one year by end of 2020– A feasible goal, in light of the near doubling of the
number of MT from 2016 to 2018 to 100,000
MT 2020: Conclusions
3. 2019 PHI for MT2020 :
I. White Paper on Building Thrombectomy Capacity: Why & How
II. Patient Journey Materials,
III. Thrombectomy Center Certification for LI and VLI countries
Thank you for your support for MT2020 Global Alliance!!
