Transcript WP4 - Musculoskeletal health status in Europe

eumusc.net
Driving musculoskeletal
health for Europe
Musculoskeletal Health in Europe
Health services utilisation
What impact do musculoskeletal
conditions have on health care
resource utilisation across Member
States?
Indicators of health services utilisation
• A number of indicators for health services utilisation are
included in the eumusc.net core and additional indicator sets.
• These indicators are grouped under the following categories:
•
•
•
•
Hospital services utilisation
Health services utilisation
Human resources
Drugs
• The following slides present each of these indicators briefly
describing the rationale for including the indicator and giving
definitions, data sources, relevant data and comments.
Hospital Services Utilisation
Hospital services utilisation core indicator
Number in-patient days related to specific
musculoskeletal diagnoses
Rationale:
Measure of efficiency of use of health care resources. Indicator often used for health
planning.
Definition:
Average Length Of Stay (ALOS) total number of occupied hospital bed-days divided by the
total number of admissions or discharges. LOS of one patient is date of discharge – date of
admission.
Data source:
WHO European Hospital Morbidity database Diseases of the musculoskeletal system and
connective tissue. ISHMT: 1300 (ICD-10 M00-99, ICD-9 0993, 1361, 2794, 446, 710-739).
Comments:
All else being equal a short ALOS will reduce the cost per discharge and shift care to less
expensive post acute services. But shorter stays could lead to adverse health outcomes.
National differences in the type of reimbursement system or health insurance plan may
affect the patient length of stay in hospitals.
Average length of stay in days for MSC,
2007 or latest available
Average length of stay in days for musculoskeletal system &
connective tissues
14.0
12.0
10.0
8.0
6.0
4.0
2.0
0.0
d ly ia s e ia ia ia ia r y ic d y
e s
k
in m d
ar dom anc nd urg pa iu l an lan Ita en pru ra g an ak atv str ga bl lan an
g
v L u
u o m
m g r
n
la o S el Ire Fin
ov Cy ve ithu lo
l
A Hu e p P er
en in F her mb
B
S
S
A
R
D K
L
G
h
d
et uxe
c
e
N
t
L
ze
ni
C
U
Hospital service utilisation core indicator
Number of hospital in-patient discharges for
musculoskeletal diagnoses
Rationale:
Measure of efficiency in use of health care resources. Indicator often used for health
planning purposes.
Definition:
Number of hospital in-patient discharges from all hospitals during the given calendar year
expressed per 1,000 population for diseases of the musculoskeletal system and connective
tissue.
Data source:
WHO European Hospital Morbidity database Diseases of the musculoskeletal system and
connective tissue. ISHMT: 1300 (ICD-10 M00-99, ICD-9 0993, 1361, 2794, 446, 710-739).
Comments:
International comparisons of hospital discharge statistics are complicated by differences in
national health information systems. Most musculoskeletal problems and conditions are
managed predominantly in primary care or as outpatients.
Hospital discharges by diagnosis per
100,000 population as percentage of all
discharges 2007
Hospital discharges by diagnosis as % all hospital discharges
Austria
Luxembourg
Germany
Belgium
Czech Republic
Hungary
Finland
Netherlands
France
Spain
Italy
United
Slovenia
Romania
Denmark
Lithuania
Bulgaria
Poland
Ireland
Malta
Cyprus
Respiratory
Circulatory
Musculoskeletal
0
5
10
15
20
Percent of all hospital discharges
25
30
Hospital services utilisation indicator
Age-standardised admission rates
Rationale:
Measure of the utilisation of hospital services for MSC and
the burden of MSC on health services.
Definition:
Age-standardised admission rates per 1,000 population for
musculoskeletal and connective tissue diseases (M00-99).
Data sources:
WHO European Hospital Morbidity database Diseases of the
musculoskeletal system and connective tissue. ISHMT 1300
(ICD-10 M00-99; ICD-9 0993,1361, 2794, 446, 710-739)
Age-standardised admission rate for MSC per
1,000 population, 2007 or latest available
Age-standardised admission rate for diseases of the musculoskeletal system &
connective tissue per 1000 population 2007 or latest available
30
25
20
15
10
5
It
Sl aly
ov
en
ia
Sl
ov
ak
i
A
ve a
ra
g
Li
th e
ua
ni
a
Fr
an
c
Fi e
nl
an
B
el d
gi
um
La
tv
ia
C
ze Hu
ch ng
Re ar y
pu
bl
G
i
er c
m
an
y
A
us
tr
ia
C
yp
ru
s
Sp
ai
n
Ire
la
nd
U
ni
P
te
ol
d
an
K
d
in
gd
N
et
he om
rla
nd
D
en s
m
ar
k
0
A
G us
L
C ux er tri
ze e m a
ch m an
Re bou y
p r
H ub g
un li
g c
F i ar
n y
B lan
el d
gi
La um
F tv
Li ran ia
th c
S l u an e
o
Sl va ia
ov kia
en
U
ni D
i
te e It a
d n aly
N Kin ma
et g r k
he do
r la m
Po nds
l
Ir e and
la
S p nd
C ai
yp n
ru
s
In-patients and day cases for MSC per 1,000
population, 2007 or latest available
35
30
25
In-patients per
1,000 population
20
Day cases per
1,000 population
15
10
5
0
Variation in utilisation of hospital services
for MSC
UK
Poland
14
14
12
12
In-patients per 1,000
10
10
ALOS
8
8
Day cases per 1,000
6
6
Age standardised admission rate
per 1,000
4
4
2
2
0
0
2000
2001
2002
2003
2004
2005
2006
2007
2003
2008
2004
2005
2006
2007
2008
Year
Year
Finland
Netherlands
18
16
16
14
14
12
12
10
10
8
8
6
6
4
4
2
2
0
0
2004
2005
2006
Year
2007
2008
2002
2003
2004
2005
Year
2006
2007
2008
Source:
EUROSTAT
2011
Hospital services utilisation core indicator
Number of surgeries hip arthroplasty
Rationale:
Volume of surgeries is product of prevalence and severity of condition
and availability of appropriate medical resources.
Definition:
Number of hip replacements performed in hospital as in-patient surgery
per 100,000 population.
Data sources:
OECD Health Database 2009 and national arthroplasty registers.
Comments:
Arthroplasty registers: Austria, Italy, Denmark, Finland, Romania,
Slovakia, Sweden, Hungary, France, England, Scotland Czech Republic,
Portugal.
Hip replacement
The number of hip replacement procedures differ
significantly across EU Member States. The volume of
surgeries is a product of:
• prevalence of the condition
• availability of appropriate medical resources
• Differences in clinical treatment guidelines and
practices
• International mobility across EU borders
Low rates may point to under-treatment or may be due
to good control of the underlying systemic disease.
Hip replacement procedures
Hip replacement, procedures per 100,000 population (in-patient)
2007
300
200
150
100
50
0
Po
la
n
Po d
rtu
g
Hu a l
ng
ar
y
Sp
ai
n
Ire
la
nd
Ita
Av ly
er
ag
Un
Fi e
nl
ite
a
d
Ki nd
ng
d
De om
n
Ne ma
rk
th
er
la
nd
Sw s
ed
Lu
e
xe
m n
bo
ur
g
Fr
an
c
Be e
lg
iu
m
Au
st
G ria
er
m
an
y
Procedures
250
Source: Surgical
procedures by
ICD-9-CM, Hip
replacement,
Procedures per
100 000
population (inpatient). OECD
Health Data 2009
- Version:
November 09
Number of Primary Total Hip
Replacements per Diagnosis and Age
Swedish Hip Register 1992-2005
Diagnosis
< 50 years
50-59 years
60-75 years
> 75 years
Total
Share
Primary osteoarthritis
53.5%
79.5%
81.6%
68.1%
75.7%
Fracture
3.5%
4.3%
8.2%
21.4%
11.7%
Inflammatory arthritis
17.3%
6.6%
4.2%
2.2%
4.5%
Idiopathic femoral head
necrosis
6.3%
2.7%
2.0%
3.8%
2.9%
Childhood disease
13.7%
4.0%
0.8%
0.3%
1.7%
Secondary osteoarthritis
1.5%
0.6%
0.7%
1.4%
0.9%
Tumor
1.1%
0.8%
0.4%
0.3%
0.5%
after trauma
0.8%
0.3%
0.2%
0.3%
0.3%
(missing)
2.3%
1.3%
1.9%
2.2%
1.9%
Total
100%
100%
100%
100%
100%
Secondary arthritis
Hospital services utilisation core indicator
Number of surgeries knee arthroplasty
Rationale:
Volume of surgeries is product of prevalence and severity of condition
and availability of appropriate medical resources.
Definition:
Number of knee replacements performed in hospital as in-patient surgery
per 100,000 population.
Data sources:
OECD Health Database 2009 and national arthroplasty registers.
Comments:
Arthroplasty registers: Austria, Italy, Denmark, Finland, Romania,
Slovakia, Sweden, Hungary, France, England, Scotland Czech Republic,
Portugal
Knee replacement procedures
Knee replacement procedures per 100,000 population 2006
200
180
160
140
120
100
80
60
40
20
d
lan
Fi
n
an
y
m
Ge
r
ium
g
bo
ur
m
Be
lg
UK
Lu
xe
ce
Ne
th
er
lan
ds
Av
er
ag
e
Sw
ed
en
Fr
an
ain
Sp
It a
ly
ar
y
Hu
ng
tu
ga
l
Po
r
Ire
l
an
d
0
Health Services Utilisation
MSC in Primary & Community Care
• People with musculoskeletal complaints are frequent
visitors to primary health care centres, hospitals, and
paramedical institutions (e.g. physiotherapy and
chiropractic).
• Comparison of GP utilisation between countries is
limited because in some countries the GP has much
more of a gatekeeping function than in others. In Spain,
Portugal, Italy, Finland, Denmark, Norway, United
Kingdom, Ireland and the Netherlands the GP has an
explicit gatekeeping role. (Kroneman et al., 2006) In
Luxemburg, Belgium, Germany, Austria, France,
Sweden and Greece direct access to most other
services is possible (Kroneman et al., 2006).
Health services utilisation core indicator
Primary care visits related to diagnostic code
Rationale:
Provides information on the burden of MSC on health services. Necessary
for planning of prevention and health care policy.
Definition:
% of annual primary care visits (all causes) that are due to MSC (as
defined by ICD10 or ISHMT).
Data sources:
National routinely collected data on primary care visits by ICD10 or
ISHMT.
Comments:
Availability of national health statistics on primary care patient visits by
diagnosis very variable between countries. Comparability problematic
because of differences in nature and use of primary care services
between countries.
Primary care visits for musculoskeletal
conditions
• In one UK study one in seven of all recorded consultations during
2006 was for a musculoskeletal problem. One in four of the
registered population consulted for a musculoskeletal problem in
that year, rising to more than one in three of older adults. The
back was the most common reason for consultation, followed by
the knee, chest and neck (Jordan et al 2010).
• Data from the second Dutch national survey of general practice
indicate neck and upper extremity symptoms are common in Dutch
general practice with GPs consulted approximately seven times per
week for a complaint relating to the neck or upper extremity (Bot
et al 2005).
• In Italy the frequency of visits to GPs for musculoskeletal
conditions ranges between 10% and 18% of total consultations
(Cimmino 2007).
The burden of MSC on primary care in the UK –
consultation rates 2003
The burden of MSC on primary care in the UK –
consultation rates for non-infectious disease
2003
Non-infectious GP consultations per 100,000 population
Netherlands: the number of persons diagnosed by the GP
as having a musculoskeletal disease or complaint per
1,000 registered patients
Total musculoskeletal disorders
Sprain
Low back pain with radiation
Arthrosis
Shoulder syndrome / PHS
133
15
15
15
14
Osteoporosis
7
Rheumatoid arthritis
4
Other disorders
77
Percentage of adults visiting GP for
MSC, UK 2006
The table below presents the percentage and
estimated number in the adult UK population who visit
their general practitioner at least once during a year
with any musculoskeletal complaint. These rates have
been consistent over the past 6 years.
How many adults consult GP with MSC per annum UK, 2006
Gender
Percentage consulting
No patients who visit per
annum (million)
Male
17
4.1
Female
23
6.0
Total
20
10.1
GP consultations for MSC by age and
gender, UK 2006
Percentage of registered patients consulting GP for
MSC per annum, UK 2006
40
35
30
Percent
25
Male
20
Female
15
10
5
0
15-24
25-44
45-64
Age
65-74
75+
Other providers of MSC care
• Occupational therapists, physiotherapists and
chiropractors provide care for those with MSC.
• It is very difficult to obtain comparable data
across the EU on consultations for MSC with
these professionals.
• One source of data is the European Health
Interview Survey (EHIS) which asks a general
questions about visits to physiotherapists,
occupational therapists and chiropractors.
Percent respondents visited health provider
in past 12 months
Percent respondents visited health provider in past 12 months
Czech Repub.
Slovenia
Wales
Physiotherapist
Austria
Chiropodist
Malta
Occupational
therapist
Hungary
Cyprus
Latvia
Belgium
0
2
4
6
8
Percent
10
12
14
Health services utilisation indicator
Outpatient / ambulatory consultations with physician or
surgeon related to diagnostic code
Rationale:
Provides information on the burden of MSC on health services. Necessary for
planning of prevention and health care policy. Provides information on how far
recommended standards of care in MSC health services are being met.
Definition:
Number of outpatient visits per 100,000 population per year for MSC.
Data sources:
National routinely collected data on out-patient visits, RA, OA, Back Pain, SPA.
Comments:
Availability of national health statistics on out patient visits by diagnosis is
variable between countries. Variability between countries on what is treated on
an outpatient basis therefore needs to be considered together with national inpatient data.
Out-patient visits for MSC (ICD10 codes
M00-99)
It is difficult to obtain comparative data on outpatients visits for MSC.
The number of out-patient visits can differ significantly
between countries. For example in Romania in 2010 the
number of outpatient visits per 1,000 population per
year for musculoskeletal conditions was 22.4 while in
Spain for 2009 the comparable number was 2.8:
Health services utilisation indicator
Day cases related to diagnostic code
Rationale:
Provides information on the burden of MSC on health services. Necessary
for planning of prevention and health care policy.
Definition:
Number of hospital day cases from all hospitals during the given calendar
year expressed per 1,000 population for diseases of the musculoskeletal
system and connective tissue.
Data sources:
WHO European Hospital Morbidity database Diseases of the
musculoskeletal system and connective tissue. ISHMT 1300 (ICD-10 M0099; ICD-9 0993,1361, 2794, 446, 710-739)
Comments:
Variability may exist between countries on what is treated as a day case.
Human Resources
•
A range of practitioners, manage musculoskeletal problems. These include
specialists, general practitioner, community pharmacists, physical
therapists (chiropractors, osteopaths and physiotherapists), behavioural
therapists (counsellors, psychologists and psychotherapists) and
complementary medicine practitioners (for example, acupuncturists and
aromatherapists).
•
Measuring human resources is problematic because concepts used for
medical specialities differ across the EU Member States. In particular
there are differences in the roles carried out by associated health
professionals such as Occupational Therapists which makes direct
comparison of human resources between countries problematic.
•
Whilst on a national level there may be good access to health
professionals there may be large regional variations. This regional
variation in availability may affect the equity of access.
Human resources core indicator
Number of rheumatologists
Rationale:
Assessment of availability (not necessarily accessibility) of health care
services.
Definition:
Number Rheumatology specialists per 100,000 inhabitants
Data sources:
Eurostat indicator; Data obtained from national administrative sources.
Comments:
Practising physicians provide services directly to patients, tasks include:
conducting medical examination and making diagnosis, prescribing
medication and giving treatment for diagnosed illnesses, disorders or
injuries, giving organized medical or surgical procedures. It describes
availability of staff for the whole country; may differ by region.
Fr
an
c
E
Lu s e
xe t o
m n ia
bo
D urg
en
m
B ark
el
gi
u
G m
re
ec
Po e
la
Sw nd
U
e
K
(E S den
n g lo v
la ak
n d ia
o
A nly
ve )
ra
ge
M
C
ze Bu alta
c h lg
R ari
ep a
u
L i b li
t
N hu c
et
he ani
rla a
n
R ds
om
a
Po nia
rt
ug
C al
yp
ru
La s
tv
Ire ia
la
nd
Rheumatology physicians per 100,000
inhabitants 2006
EUROSTAT
Practising rheumatology physicians per 100,000
inhabitants, 2006
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Human resources core indicator
Number of orthopaedic surgeons
Rationale:
Assessment of availability (not necessarily accessibility) of health care
services.
Definition:
Number orthopaedic surgeons per 100,000 inhabitants
Data sources:
National statistics and professional organisations
Comments:
Some problems in obtaining comparable data between countries, some
collect practising, others licensed etc. Availability of staff may differ by
region.
Orthopaedic specialists per 100,000
inhabitants 2010
Number orthopaedic specialists per 100,000 inhabitants
18
16
14
12
10
8
6
4
2
Sw
ed
en
an
y
G
er
m
ai
n
Sp
al
um
Be
lg
i
rtu
g
Po
tri
a
Au
s
nl
an
d
Fi
ia
Es
to
n
ub
l
ic
UK
Re
p
Cz
ec
h
Fr
an
ce
Ne
th
er
la
nd
s
0
Number of practising Occupational Therapists per
100,000 inhabitants 2011
COTEC
Number of practising occupational therapists per 100,000
inhabitants 2011
120
100
80
60
40
20
Lu
Fi UK
n
G lan
er d
m
Be any
lg
De ium
nm
Sw ark
ed
en
xe It
m aly
bo
Cz
ur
ec
g
L
h
at
Re vi
pu a
bl
i
Sp c
G ain
re
ec
Cy e
p
Fr rus
a
P o nc
Ne r e
th tug
er al
la
n
Au ds
Sl s tr
ov ia
en
ia
0
Physiotherapists
Number of Physiotherapists per 100,000 inhabitants 2005
250
200
150
100
50
an
c
G
er e
m
Ne
an
th
y
er
la
nd
Sw s
ed
e
Be n
lg
iu
m
De
nm
ar
k
Fi
nl
an
d
tri
a
Fr
Au
s
Ita
ly
UK
Ire
la
nd
G
re
ec
e
Sp
ai
n
0
Number of diagnostic DXA scanners in
EU
Drug use
• In recent years, for the majority of MSC, there has been considerable
progress in medical and surgical management techniques leading to a
reduction in the pain and disability arising from these conditions. In
particular there have been significant advances in the effectiveness of
treatments for RA and there is evidence to suggest that the
improvement in the health status of those with RA can be attributed
to the more aggressive use of and increased accessibility to, these
treatments (Heiberg et al 2005;Krishnan et al 2003; Uhlig et al 2008).
• Treatment of RA focuses on the suppression of inflammation. It is
treated with non-steroid anti-inflammatory drugs (NSAIDs) usually in
combination with disease modifying antirrheumatic drugs (DMARDs).
In the late 1990s so called ‘biologics’ such as TNF inhibitors were
introduced. They have a strong effect on inflammation and can
prevent or slow the progression of joint erosion. These drugs are
expensive. A 2007 study estimated the costs at between 9,00018,000 Euros per patient per year ( Engel-Nitz 2007).
Variations in drug use
• Across the EU in recent decades there has been an
upward trend in expenditure on pharmaceuticals.
• There is a wide variation between different countries
• Factors in variation include:
• Differences in the demography and health status of the
population e.g. proportion of elderly in the population.
• Differences in organization and financing of pharmaceuticals
supplies e.g. reimbursement policies.
• Cultural differences in the use of medication.
• Differences in clinical practice e.g. differences in prescribing
practice.
• Differences in service organisation and delivery e.g. access to
specialists.
Drug use indicator
Self-reported medication use for MSC
Rationale:
Health resources utilization - relates to accessibility, quality of care
and costs
Definitions:
Percent of population who report having used medication prescribed
by a physician during the past 2 weeks for pain in joints, neck or back
Percent of population who report having used medication NOT
prescribed by a physician during the past 2 weeks for pain in joints,
neck or back
Data sources:
EHIS and National Health Interview Surveys
Reasons for long-term medical
treatment
D
U
en K
m
ar
k
M
al
C ta
yp
r
Fi us
nl
a
Fr nd
an
ce
Au
s
H tria
un
g
Sl ary
ov
ak
i
Sp a
ai
La n
R tvia
om
a
Es n ia
to
C
ni
ze
P
ch o a
l
R an
ep d
G u bl
er i c
m
L an
Lu i thu y
xe an
m ia
bo
ur
g
EU
Bu 25
lg
a
Ire ria
la
nd
N
et It
he al
rl a y
Be nds
lg
i
G um
re
Po e ce
rt
Sl uga
ov l
e
Sw nia
ed
en
Percentage
Longterm treatment because of longstanding
troubles with muscles, bones and joints (arthritis,
rheumatism)
% reporting medical long term treatment for
troubles with muscles, bones and joints
45
40
35
30
25
20
15
10
5
0
Percentage of all respondents taking
medication for MSC in past 2 weeks
Percentage of respondents taking prescribed and non-prescribed
medications for MSC in past 2 weeks
18
16
Prescribed pain
in joints
14
Percent
12
Prescribed pain
in back
10
8
Non-prescribed
pain in joints
6
4
2
0
Cyprus
Malta
Slovenia
Latvia
Austria
Czech
Repub
Hungary
Drug use indicator
Pharmaceuticals consumption for MSC
Rationale:
Health resources utilization - relates to accessibility, quality of care and costs
Definitions:
Amount of medicine use (based on sales statistics) per day per 1,000 population for
treatment of MSC (ATC codes M) expressed in Defined Daily Doses (DDDs) per day.
Amount of medicine use (based on sales statistics) per day per 1,000 population for
Antiinflammatory and antirheumatic products (ATC codes M01) expressed in Defined
Daily Doses (DDDs) per day.
Data sources:
OECD Health database - data obtained from national medicine sales register
Comments:
There are a number of possible sources of under-reporting of drug sales in different
countries. Most drugs in this area can be used for different non MSC conditions
therefore difficult to interpret.
Pharmaceutical consumption, Musculoskeletal
System, Defined daily dosage per 1000 inhabitants
per day
Pharmaceutical consumption musculoskeletal system, DDD per 1000
inhabitants
DDD per 1000 inhabitants per day
160.0
140.0
Czech Repub
120.0
Denmark
Finland
100.0
Germany
80.0
Hungary
Netherlands
60.0
Portugal
40.0
Slovakia
Sweden
20.0
0.0
1999
2000
2001
2002
2003
2004
2005
2006
2007
Pharmaceutical consumption, M01AAntiinflammatory,antirheumatic prod. non-steroids,
Defined daily dosage per 1000 inhabitants per day
Pharmaceutical consumption M01A antiinflam. antirheumatic prod.
non-steroids, DDD per 1000 inhabitants
DDD per 1000 inhabitants per day
90.0
80.0
Czech Republic
70.0
Denmark
60.0
Finland
50.0
Germany
Hungary
40.0
Netherlands
30.0
Portugal
Slovak Republic
20.0
Sweden
10.0
0.0
1999
2000
2001
2002
2003
2004
2005
2006
2007
Drug use indicator
Pharmaceuticals sales for MSC
Rationale:
Health resources utilization - relates to accessibility, quality of care and
costs
Definitions:
Sales of pharmaceutical products for MSC (ATC codes M) or sales of
pharmaceutical products for Antiinflammatory and antirheumatic nonsteroid products (ATC codes M01) on the domestic market based on retail
prices (the final price paid by the customer). Expressed as: i. % Total sales
ii. US$ Purchasing Power Parity (PPP) per annum.
Data sources:
OECD Health database - data obtained from national medicine sales register
Comments:
There are a number of possible sources of under-reporting of drug sales in
different countries. Most drugs in this area can be used for different non
MSC conditions therefore difficult to interpret.
Pharmaceutical sales, Musculoskeletal system per
capita US$ PPP
Pharmaceutical sales musculoskeletal system per capita US$ PPP
35
30
per capita US$ PPP
Czech Republic
Denmark
25
Finland
Germany
20
Hungary
15
Netherlands
Portugal
10
Slovak Republic
Sweden
5
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
Pharmaceutical sales, M01A Antiinflam,
antirheumatic prod. Non-steroids per capita US$
PPP
Pharmaceutical sales M01A antiinflam antirheumatic prod. nonsteroids per capita US$ PPP
25
Czech Republic
per capita US$ PPP
20
Denmark
Finland
15
Germany
Hungary
Netherlands
10
Portugal
Slovak Republic
5
Sweden
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
Pharmaceutical sales musculoskeletal
system, % total sales
Pharmaceutical sales musculoskeletal system, % total sales
14.0
12.0
Czech Republic
Denmark
% total sales
10.0
Finland
Germany
8.0
Hungary
6.0
Netherlands
Portugal
4.0
Slovak Republic
Sweden
2.0
0.0
1999
2000
2001
2002
2003
2004
2005
2006
2007
Pharmaceutical sales M01A Antiinflam,
antirheumatic prod. non-steroids % total sales
Pharmaceutical sales M01A antiinflammatory, antirheumatic prod.
Non-steroids % total sales
9
8
6
5
2002
4
2007
3
2
1
ga
l
rtu
Po
nl
an
d
Fi
ic
Re
p
bl
Cz
ec
h
Re
pu
ak
Sl
ov
ub
l
ic
um
Be
lg
i
m
ar
k
De
n
an
ce
Fr
Sw
ed
en
an
y
0
G
er
m
% total sales
7
International variation in use of TNF
inhibitors & DMARD
•
Jonsson et al (2008) examined international variation in the use of TNF
inhibitors and of conventional DMARDS for the treatment of rheumatoid
arthritis for the period 2000-2006.
•
High uptake was observed for Sweden, the Netherlands and Finland,
France Spain and the UK were around the EU 13 average. Germany Italy
and countries of central and eastern Europe were below this average.
•
Possible reasons for differences proposed by the authors were:
•
•
•
•
•
Differences in GDP (although there were large differences between
countries with similar GDP)
Differences in relative price levels
Differences in national preferences and priorities
Variations in access to rheumatologists
Variations in clinical guidelines have also been suggested as a reason for
variation in usage of biological treatments (Kobelt & Kasteng 2009).
eumusc.net is an information and surveillance network promoting a comprehensive European strategy to optimise
musculoskeletal health. It addresses the prevention and management of MSC’s which is neither equitable nor a priority within
most EU member states. It is focused on raising the awareness of musculoskeletal health and harmonising the care of rheumatic
and musculoskeletal conditions.
It is a 3 year project that began in February 2010. It is supported by the European Community (EC Community Action in the Field
of Health 2008-2013), the project is a network of institutions, researchers and individuals in 22 organisations across 17
countries, working with and through EULAR.
eumusc.net: creating a web-based information resource to drive musculoskeletal health in Europe
www.eumusc.net
Disclaimer
The Executive Agency for Health and Consumers is not responsible for any use that is
made of the information contained within this publication