Transcript Snímek 1
The Migraine management in Poland Jacek Rozniecki Dept. of Neurology Medical University in Lodz Country description • • Demography – 38 mln Economy – GDP (Gross Domestic Product) – 1047 mld (bln) PLN = $385 mld (bln) – GDP/capita = $10 200 – HC expenditure – 7% GDP/capita = $744 % of population in „new” EC countries Health care system • Description of key Regulatory/Reimbursement assumptions – – – – – Free of charge (epilepsy*, PD, MG) Lump (epilepsy**) (~$1) 30% reimbursement 50% reimbursement Full charge • Reimbursement/ triptans – Full charge, no reimbursement The role of Headache Society, Centers and Specialists in migraine management • Migraine Investigation Section of the Polish Neurological Society • Polish Headache Society (in the structure of IHF) – National congresses of PHS – International conferences of PHS – Pharmaco-meetings • Treatment – „old guidlines“, „new guidlines“ - in progress • Education – – – – – Headache Academy (for neurologists) School of Headache (for GPs) Headache courses for neurological specialty Booklets for headache patients Polish Headache Association • Headache centers – Lodz, Warsaw (3), Lublin, Poznan, Gdansk The role of GPs in migraine management (supposed to be) • Part in migraine treatment – – – – – First-line physician Direct and fast contact No need for diagnostics No need for special conditions for routine patients care No restrictions in terms of pharmaceuticals prescrptions • Education – Courses, and cooperation with a neurologist • Guidelines – The same as for neurologists Headache care system - view of GP (The questionnaire prepared by Goril Bruvik Gravdahi from Norvegian National Headache Centre Department of Neurology and Clinical Neurophysiology Trondheim, Norway) Headache care system - view of GP Headache care system - view of GP Headache care system - view of GP „Current“ situation in migraine therapy Yearly worldwide units (millions) Ergotamine-based compounds NSAIDs, aspirin and others Narcotic-based compounds Triptans 1 800 1 600 1 400 1 200 1 000 800 600 400 200 0 1995 1996 1997 1998 1999 Guidetti V., MSD Symposium, Barcelona 2001 The migraine awareness among population • Specialist – Continuous education – Easy access to up to date clinical research data, publications, EBM guidlines – Participation in clinical and scientific meetings • GPs – Continuous education – Possibility of quick consultation with a neurologist and/or headache specialist – Motivation of not sending a patient to a specialist • Patients – – – – – – Easy access to popular medical publications about common primary headaches Access to simple self-evaluation/self-diagnostic tools Patients‘ associations Easy access to patients‘ internet forum Enough of doctor‘s time for a patient Patients‘ trust in their GP The POSSIBILITIES how to IMPROVE it! • Key activities: – Education, awareness and info for – Neurologists – GPs – Patients – Guidelines, EBM – Referal system for consultations with neurologists and headache specialists – Internet forum and consultations – National headache journal widely open for neurologists as well GPs • International cooperation – Guidelines – Meetings – International headache journals subscrptions • Free market mechanisms for triptans The POSSIBILITIES how to IMPROVE it! • Maxalt (rizatriptan) - $ 13/ tab = Euro 9/ tab • Zomig (zolmitriptan) - $ 12/ tab = Euro 8,7/ tab • Relpax (eletriptan) - $ 7,5/ tab = Euro 5,2/ tab • • • • • Imigran (sumatriptan) – $ 6,5/ tab = Euro 4,7/ tab Sumamigren (sumatriptan) - $ 5,9/ tab = Euro 4,2/ tab Sumigra (sumatriptan) – $ 5,2/ tab = Euro 3,9/ tab Cinie (sumatriptan) - $ 3,3/ tab = Euro 2,4/ tab ............................... - $ 1,4/ tab = Euro 1/ tab or reimbursements (realistically – no chance!)