Inverted benefit pyramid a lifesaver for inefficient health care system

During a December 4 meeting of the Permanent Subcommittee on the Organization of Health Care, dedicated to planned changes in outpatient specialized care and hospital care, Agata Smiglewska, director of the Health Ministry's Department of Analysis and Strategy, reported that the ministry is working on a draft of the so-called inverted pyramid of benefits. - The effect is expected to be a reversal of the level of financing, so unfavorable in our country, where the entire burden is placed on the hospital, she noted.

Medication taken at home instead of in hospital

Representing the patient community, Aleksandra Rudnicka, spokesperson for the oncology association Sanitas, pointed out that inverting the pyramid of benefits and making pill therapies or subcutaneous therapies available instead of hospital administration is not only a system benefit, but also an improvement in the patient's quality of life. - Meanwhile, quality of life is not taken into account when evaluating medical technologies. There is no such parameter. We talk about clinical effectiveness , and we do not evaluate drugs in terms of their impact on the patient's quality of life or indirect costs. A patient who gets such treatment can work, has more time for family. Although subcutaneous or tablet technologies are sometimes very expensive compared to intravenous administration, all the benefits must be calculated, she argued.

She mentioned the dramatic shortage of beds in hematology departments.

- After all, there are procedures in place for patients to transition to outpatient care. Patients who have drugs administered intravenously for a few hours in a few days could receive tablet drugs. Not to mention children with hemophilia, for whom subcutaneous treatment should be made as widely available as possible," pointed out Aleksandra Wilk, director of the Lung Cancer Section at the "It Cures Itself" Foundation, thanking the health ministry for announcing reimbursement for subcutaneous therapy - the first immunotherapy in January next year: - This really improves the quality of life, because 5 to 8 minutes of administration instead of an hour maximally reduces the length of stay in the facility, even if the patient commutes to it.

Unlock cancer centers

Prof. Barbara Radecka, head of the Oncology Clinic at the Opole Oncology Center, reminded that in addition to the increase in the incidence of the disease, it is the prolongation of the survival rate of cancer patients that results in an increase in the number of patients. - The statistical patient has been in the system for more than two years in continuous treatment, with new patients arriving every month. So the system is simply swelling. We have striven to make cancer a chronic disease, and it has become so. There are patients treated for a year, but also 10 years," she pointed out.

This is why pill and subcutaneous therapies are becoming so important, in her opinion. - A tablet-treated patient should not enter the clinic at all. Everything can take place on an outpatient basis," Prof. Barbara Radecka pointed out. She stressed that subcutaneous therapies are a breakthrough in oncology. - Biologic drug manufacturers will massively introduce studies to test subcutaneous forms, where an hourly or 1.5-hour infusion is replaced by an injection of a few minutes, she added. Prof. Barbara Radecka called for reimbursement of such a two-component drug in breast cancer. - In the European Union, only Poland and Belgium do not have reimbursement. I can't imagine that in an era when I have been using a subcutaneous biologic drug in breast cancer patients for 8 years, I would have to return en masse to the intravenous form," she pointed out.

- This is an ampoule that is injected into the thigh, and intravenous drugs have to be dissolved in the cytostatics laboratory by pharmacologists, who are in short supply in hospitals, she said. - So if we look at all these procedures, while the price of a subcutaneous drug on the invoice is impressive, the benefits that relieve the burden on the system are colossal. That's why any solution that moves the patient away from the hospital bed, that reduces the length of their stay in the treatment facility, is simply extremely important, and I would like each of you who makes a decision in this aspect to always keep this in mind," she appealed.

Out-of-hospital treatment pays off

Dr. Michal Seweryn, a pharmacoeconomist and epidemiologist at Andrzej Frycz Modrzewski University in Krakow, talked about the conclusions of the analysis conducted jointly with the Polish Lung Cancer Group in the report. - We traced the path of patients treated in the drug program, on which we spend more than a billion zlotys, and found that it is very far from optimal, he informed. He pointed out that almost half of the patients surveyed said that commuting to hospitals greatly disorganizes their lives. Patients commute an average of 87 kilometers, just to take a medication that, in pill or subcutaneous form, they could take at home. Commuting costs are also a burden, as well as those associated with sickness absences of patients and those who care for them.

The Polish Lung Cancer Group, consisting of Poland's most prominent clinicians, points out that given the increase in the incidence of the disease, too few training specialists in oncology (15 residents are enrolled for every 200 places), there is a need for optimization in the area of drug programs.

Subcommittee chairwoman, MP Józefa Szczurek-Zelazko, added that there are increasing signals to MPs that in drug programs patients are forced to travel tens of kilometers, while many of the procedures could be had locally. She appealed to representatives of the Health Ministry to analyze and use the conclusions formulated during the Subcommittee's meeting.