The importance of cost measurement in the health care system has been growing in recent decades. By estimating the direct and indirect costs of diseases, better decisions can be made about how to spend public money to treat them.
Social Security counts
The Social Insurance Institution's expenditures on social insurance disability benefits have been increasing in recent years. In 2021, compared to 2020, they increased by nearly PLN 2 billion.
However, the share of spending on disability benefits in total spending is gradually declining. In 2017, they accounted for 40%, and in 2021. - 31,0%. The number of recipients of disability benefits is also decreasing. At the same time, the share of expenditures for sickness absence, paid by Social Security and from workplace funds, is increasing significantly.
Prof. Gertruda Uścińska, president of the Social Insurance Institution, said that last year 6.7% more sick leaves were issued compared to the previous year. Instead, the reason for layoffs has not changed over the years - diseases of the skeletal-muscular system, pregnancy, childbirth, puerperium, diseases of the respiratory system, injuries and poisoning. - During the pandemic period, mental disorders jumped into the top five, then dropped to seventh place. But last year they were again in fifth place," the Social Security president pointed out. She pointed out that middle-aged people are the most frequent users of sick leave. - Contrary to appearances, absenteeism among people 50+ and 60+ is not higher, she stressed. She added that prevention, modern methods of diagnosis and treatment, and rehabilitation result in lower expenses for Social Security.
Unmet needs in breast cancer treatment
Prof. Barbara Radecka, head of the Oncology Clinic with Day Episode at the Opole Oncology Center, reminded that breast cancer is still the most common malignant tumor in women and the leading cause of cancer deaths among women of working age. Therefore, optimization of breast cancer treatment strategies should remain one of the priorities of the Polish health care system. The expert reported that new drugs have recently entered reimbursement, and the number of patients receiving therapy is increasing. She also drew attention to the group of patients with early hormone-dependent cancer who have a high risk of recurrence.
Despite its early stage, the disease is more dangerous in these patients - in this group, despite available treatment, recurrence in the form of distant metastases occurs in up to 30%.
The solution for these patients lies in new treatment options - the combination of hormone therapy with targeted therapy with one of the CDK4/6 inhibitors, for which efficacy in reducing the risk of disease recurrence has been demonstrated. Data from the clinical trial show a 34% reduction in the risk of invasive disease and a 34% reduction in the risk of distant metastasis. According to experts, the results obtained are particularly important because the reduction in the risk of recurrence was demonstrated in a population that is at high risk of relapse. - This is about 1200-1500 patients per year," Prof. Radecka pointed out. She mentioned that abemaciclib is already well known to Polish doctors, as they have been using it in advanced disease for the past four years. - Oncologists love this drug because of its special therapeutic value, the possibility of oral use at home and relatively good tolerance by patients. We are waiting for reimbursement and hope it will happen in the coming months," she said. She added that the drug's manufacturer has stepped forward with an early access program in several centers in Poland, providing the drug for a symbolic 1 euro, and dozens of women in Poland are already benefiting from this therapy. - We hope it will be available to all patients, as the drug increases the chance of a complete cure," she said.
Systems for continuous glycemic measurement in gestational diabetes mellitus
Prof. Leszek Czupryniak, head of the Department of Diabetology and Internal Medicine at WUM, pointed out that almost 3/4 of the cost of treating diabetes is the cost of treating complications. The continuous scanning glucose measurement (isCGM) system - FreeStyle Libre (FSL) - which allows the patient and the doctor to obtain information on glucose levels and glycemic variation throughout the day, prevents diabetes complications. - This is a technological revolution in diabetology and brings it into the 21st century. The decision to reimburse this technology was very wise, because we can't prevent type 1 diabetes, in type 2 it is difficult, but we can prevent its complications. Fortunately, we have a partner in the Ministry of Health who understands this," stressed Prof. Czupryniak.
In Poland, the continuous glycemic monitoring system was reimbursed from 2019 for the pediatric population, and from 2023, reimbursement is available to all adults with diabetes who give themselves insulin a minimum of three times a day. The reimbursement also extended to blind diabetics and pregnant women who use insulin (even one dose per day). A group of patients that could also particularly benefit from access to continuous glycemic monitoring are pregnant women with gestational diabetes who do not require insulin. - This would reduce the number of perinatal complications, Prof. Czupryniak pointed out. This would translate into a reduction in cesarean sections and future obesity and type II diabetes.
Prof. Leszek Czupryniak argued that virtually every diabetic should use the device for at least two weeks for educational purposes. - This opens patients' eyes to how both diet and lifestyle affect sugar levels in the body, he pointed out. He added that talks are underway with the health ministry so that every diabetic patient can use such a device once a year for at least two months. The technology would also be helpful to bedridden patients, in nursing homes, ZOLs or DPS. - It's worth spending more today for less in the future," the expert concluded.
Krzysztof Łanda, founder of the WHC Foundation, added that the combination of new GLP 1 drugs and continuous glycemic monitoring systems could postpone the use of insulin therapy by up to 10 years.
Extension of phlozin refunds
Prof. Artur Mamcarz, head of the III Department of Internal Medicine and Cardiology at WUM reminded that there are about one and a half million people with heart failure in Poland. Prof. Przemysław Mitkowski, president of the Polish Cardiac Society, head of the Cardiac Electrotherapy Laboratory, 1st Department of Cardiology, Department of Cardiology, Poznan University of Medical Sciences, added that Poles have a higher cardiovascular risk compared to other European residents, such as the French or Spaniards. Therefore, the availability of effective treatments is crucial. - Flozins are a hit in cardiology, diabetology and nephrology. Patients who have had shortness of breath throughout the day are climbing the third floor without shortness of breath on the third or fourth day after starting this treatment. And not using these drugs in patients with heart failure is a medical malpractice," pointed out Prof. Artur Mamcarz. - Flozins are an extremely convenient form of therapy with negligible side effects, which prolongs life, added Prof. Przemysław Mitkowski.
Prof. Mamcarz said that guidelines on the use of flosins in heart failure patients with preserved ventricular systolic function will be released in the fall. - To date, we have not had an intervention that benefits these patients, he said.
Experts pointed out that these drugs could be included in the 75+ list. In the current economic climate, senior patients often forgo buying needed medications, and a study by the Coalition "To Help the Dependent" found that 80 percent of seniors happened not to buy prescriptions because of drug prices. So although the cost of a flozone subsidy seems small - about PLN 50 for a month's therapy, in senior patients with multiple diseases who buy a large number of drugs - even this small amount can be a significant cost and a significant burden on the household budget.
Prof. Ryszard Gellert, national consultant in nephrology, also spoke about flosins. He recalled that there are 4.7 million people living with kidney failure in Poland. Annually, premature deaths due to this
100,000 people, as many as from chronic cancer. - The disease shortens life expectancy by 30%, which for a 20-year-old, for example, means 18 years. The problem is that most patients don't know they have the disease. Meanwhile, a diagnostic test costs PLN 15," he informed. Patients with chronic kidney disease have access to reimbursed phlazines,
but with limited indications. Only about 2,000 patients have qualified for treatment with flosins, thanks to reimbursement in chronic kidney disease, which takes effect in July 2022, in six months, although it was estimated that there would be three times as many. The situation would be changed by changing the reimbursement provision from a quantitative one ("albuminuria ≥200mg/g") to a qualitative one, namely: "albuminuria or proteinuria."
Partnership for the Prevention and Treatment of Obesity
In December 2022, on the initiative of the Polish Society for the Treatment of Obesity and the Institute of Healthcare Management at Lazarski University, the Partnership for the Prevention and Treatment of Obesity was established to develop recommendations for key actions in the area of prevention and treatment, including in particular recommendations for the creation of a multi-year Nationwide Obesity Strategy.
A pilot program for comprehensive medical care of patients with surgically treated giant obesity (KOS-BAR) is currently in operation.
Prof. Mariusz Wyleżoł, vice president of the Polish Society for the Treatment of Obesity, reminded the audience that in Poland there are about 6 to 8 million people suffering from obesity, who are exposed to a gigantic number of complications and have about 40% higher risk of cancer. The expert pointed to the need to start a dialogue with the food industry to reduce the sugar content of many products. He stressed that obesity, like any disease, must be treated - first pharmacologically, and if that doesn't work, surgically.
The new GLP1 drugs used to treat obesity are yielding double-digit percentage reductions in body weight. - I compare this breakthrough to the introduction of antibiotics," he said. He added that making these drugs available to obese people in the reimbursement system would clean up the funding situation for obesity treatment. - It would then be up to doctors to decide when to reach for these drugs, he added.
The expert also drew attention to the problem of obesity among children and its devastating impact on their health. Prof. Artur Mamcarz added that this will result in cardiovascular and oncological complications. - If we don't do something today, we will face an avalanche of complications in adolescent obese youth in a few years, he warned.
