"We Count Our Health" - Medical Rationale of State debate

The NFZ activity report for the previous year clearly shows that waiting times for appointments with specialists - both for stable and urgent cases - have increased. Despite increasing expenditures, the number of services provided has not increased and continues to fail to meet patient demand.

The Medical Rationale of State experts emphasized the growing importance of access to prevention and effective therapies in terms of measuring health outcomes and overall costs in the Polish health care system.

Zbigniew Derdziuk, chairman of the Social Insurance Institution (ZUS), said that we spend PLN 29 billion on the sickness fund, of which PLN 19 billion on sick leave. - As a society we are aging, and if we don't take care of our health, there will be no one to work and no one to take care of the sick, he warned.

PLN 6 billion costs us for non-adherence to medicine (adherence)

Prof. Aleksander Prejbisz, head of the Department of Epidemiology, Prevention of Cardiovascular Diseases and Health Promotion at the National Institute of Cardiology in Warsaw, noted that adherence to medical recommendations is not only about taking medications, but also lifestyle modification. And we have a problem with both. - One-third of patients with lipid disorders or hypertension, after visiting the doctor and receiving a prescription, do not buy the drugs. This is a social problem, because we are talking about millions of patients. Of those who start treatment, half do not make it to the end of the first year of therapy. The least number of such people is in the 70- and 80-year-old group. The problem of non-adherence to medical recommendations affects young middle-aged patients, he enumerated. According to him, one of the reasons is the lack of quality in health care. - The system is quantitative, not qualitative. It motivates neither the doctor nor the patient. And in some countries, the amount of drug reimbursement depends on the improvement of the patient's results, he said.

Prof. Alexander Prejbisz pointed out that today access to medical knowledge is easier, because the patient can find many things on the Internet. - This changes the relationship between doctor and patient towards shared responsibility, partnership, understanding, he stressed.

He added that he tries to make it easier for patients to comply by prescribing compounded preparations so that they take fewer pills. He pointed out that in the case of chronic diseases, the patient doesn't see the effects of treatment because it prevents dangerous complications. - It is important to explain this to the patient," he said.

Prof. Artur Mamcarz, head of the Department of Internal Medicine and Cardiology at WUM, added that the patient and his family can see the effects of not following medical recommendations if the patient suffers a stroke or heart attack. He cited the example of Portugal, where 30 years ago the effectiveness of hypertension treatment was 3 percent, and today it has become a benchmark for the EU, reaching 50 percent. - Portugal has implemented a program to improve adherence to medical recommendations targeting doctors, patients, pharmacists and NGOs, he reported.

According to him, one of the reasons for non-adherence is inadequate communication between doctor and patient.

- This is a problem of many chronic diseases, which generates medical, but also systemic and financial losses. In Poland they are estimated at 6 billion zlotys, in the EU at more than 120 billion euros. And it's not just money, because 200,000 people in Europe die every year because they don't follow therapeutic recommendations," he said.

Prof. Artur Mamcarz appealed that in connection with the International Day of Therapeutic Adherence, which falls on March 27 next year during the Polish presidency of the EU, the Medical Rationale of State should initiate the formation of a coalition bringing together patient organizations and scientific societies dealing with chronic diseases to improve adherence to medical recommendations.

95% of those hospitalized for RSV are not premature babies

Prof. Maria Katarzyna Borszewska-Kornacka, a neonatologist and president of the Coalition for the Premature Infant Foundation, spoke about a new immunization method for RSV infection that is now available in the US and many European countries. The new monoclonal antibody nirsevimab, which targets the virus that primarily affects children under the age of five, and virtually every child under the age of two will come into contact with it, effectively protects against infection. RSV, is responsible for about 70 percent of lower respiratory tract infections in infants under the age of one. It is 4 times more infectious than the influenza virus, and the number of hospitalizations caused by it is almost 16 times that due to influenza. It causes swelling and exfoliation of respiratory epithelial cells, leading to a build-up of thick secretions that make breathing difficult.

An RSV infection prevention program has been operating in Poland since 2008. Premature babies, children with bronchopulmonary dysplasia, congenital heart defects and, as of this season, children with SMA and cystic fibrosis can benefit from free immunoprophylaxis. That's about 1.5 percent of children this age. - Premature babies receive antibodies administered at the beginning of the season five times, which means five injections, the expert reported. Nirsevimab is administered once. - We want all children to receive it, because 95 percent of young patients hospitalized for RSV are not premature babies. Infection in toddlers often goes very badly, sometimes they end up in intensive care," she argued. She stressed that already 17 countries have issued a positive recommendation for administering the antibody to all children. Such recommendations have also been issued by the Polish Society of Vaccinology, the Polish Society of Family Medicine and the Polish Pediatric Society. The latter has prepared the RSV Health Policy Program, which aims to eliminate the risk of hospitalization due to RSV infection.

The program was submitted to Deputy Minister Wojciech Konieczny. According to experts, the administration of nirsevimab should be a guaranteed benefit in the hospital for all newborns born before the season, and for children who are born out of season - implemented in primary care. The Polish Society of Vaccinology says in its recommendations that passive prophylaxis against RSV should be introduced into the Immunization Program, and suggests that the name of the program should then be changed to the Immunization Program - because passive prophylaxis is not vaccination, although the form of administration and effect are the same.

Prof. Maria Katarzyna Borszewska-Kornacka also informed that there is already a vaccine available in Poland for pregnant women to produce antibodies and pass them through the placenta to their children. It is under evaluation by the AOTMiT. - The problem is that not all women want to be vaccinated. So the optimal solution remains one injection for all children," she pointed out.

9 million sick - cost 3.6 billion a year

- There are 9 million of us, and only 1 percent have a diagnosis and treatment. Going to the doctor we hear to do something with ourselves and to come back if we lose weight. We don't have access to treatment, and if we take it at our own expense, we hear that we've gone easy on ourselves," said Katarzyna Glowinska, president of FLO - Foundation for the Treatment of Obesity.

- It is a very difficult disease to treat, and strong willpower does not allow one to restrict caloric supply. The patient is unable by willpower to change the abnormal signaling of environmental, metabolic, genetic, hormonal factors in the central nervous system," explained Professor Lucyna Ostrowska, president of the Polish Society for the Treatment of Obesity.

- We live in a time when we have lived to see effective pharmacotherapy for the treatment of obesity disease and complications. Only still this pharmacotherapy is out of reach for most patients due to the price. As the Polish Society for the Treatment of Obesity, we call for the possibility of reimbursing these drugs at least for a narrowed group of patients. The disease is multi-causal, and we look at it from the perspective that the patient is eating too much. We don't look at why he or she has caused a positive energy balance and has a disturbance in energy homeostasis," she added.

Prof. Mariusz Wyleżoł, president-elect of the Polish Society for the Treatment of Obesity, head of the Warsaw Center for Obesity Treatment and Bariatric Surgery at Czerniakowski Hospital, lamented that in Poland, obesity disease is treated only palliatively, dealing with alleviating its consequences rather than removing the cause. - The results of scientific studies clearly show that with the cure of obesity disease, we are able to achieve the cure of diabetes with restoration of normal glycemic levels and withdrawal of drugs, as well as hypertensive disease and restoration of proper blood pressure values also with withdrawal of drugs. And in many patients qualified for hip and knee replacement surgeries, we can dispense with these surgeries, thanks to improvements in overall health and musculoskeletal function," he enumerated. He pointed to the urgent need to organize causal treatment for obese patients. - We have such an opportunity within the framework of bariatric surgery in the KOS BAR program, he added.

Dr. Agnieszka Gorgoń-Komor, vice chairman of the Senate Health Committee, pointed out that we have become accustomed to obesity and are unable to talk to patients about it. - I realized as a doctor that sometimes we are afraid to talk to patients so as not to offend them. And obesity is the starting point for 200 other disease entities. And if we leave a patient with obesity, we will spend exorbitant funds on corrective medicine. So we need to treat patients with obesity not only symptomatically, but also causally," she pointed out.

- We can't just focus on obesity prevention, because the scale of the phenomenon shows that we need to address treatment, especially as the costs of these diseases are rising," added Dr. Malgorzata Galazka-Sobotka, director of the Institute of Healthcare Management at Lazarski University, vice chair of the Council of the National Health Fund
30% slowdown in cognitive decline

During the Medical Rationale of State, experts pointed to new therapeutic options that are changing the course of Alzheimer's disease. Prof. Konrad Rejdak, head of the Clinical Department of Neurology at the University Clinical Hospital No. 4 in Lublin, said that after a huge breakthrough in the treatment of MS, it is time for a breakthrough in the treatment of neurodegenerative diseases. Prof. Jacek Staszewski of the WIM Affidea Center for Treatment of Memory Disorders pointed out that anti-amyloid therapies cause the progression of Alzheimer's disease symptoms to be halted by about two to three years.

- This is a breakthrough that will improve the quality of life for patients, their families and caregivers, he stressed. The clinical efficacy of amyloid targeting therapies (ATTs) in patients with early symptomatic Alzheimer's disease has been demonstrated in phase 3 clinical trials. That's a 30% slowdown in cognitive deterioration in the early stages of Alzheimer's disease. - And 80 percent removal of the abnormal protein. And this is part of the pathophysiology, not the only one, but the basic one," Prof. Jacek Staszewski pointed out.

- These drugs are only used in early-stage patients, primarily in mild cognitive impairment. So we need to identify these patients and make an early etiological diagnosis. To do this, we should think about implementing an entire system that would identify patients with memory disorders at an early stage. We need to implement a program of broad diagnostics that would allow outpatient diagnosis of dementia disease or preclinical dementia status within memory disorder clinics. Worldwide, such clinics are very popular. They are cost-effective. They are based on the cooperation of a neurologist, geriatrician, psychiatrist, neuropsychologist. They enable comprehensive and most effective care," he explained.

Dr. Grzegorz Cessak, president of URPL, said the EMA is conducting a re-evaluation of lekanemab. The drug is available in the US, Japan, China, Korea, Hong Kong, Israel, the United Arab Emirates and the UK.

- This disease places a huge burden on caregivers and the system. There is a need for early diagnosis and a system that allows the patient to stay at home for as long as possible, to support the caregiver in providing home supervision," Prof. Jacek Staszewski pointed out.

1 in 10 patients are burdened with mutations

1 in 10 patients with metastatic, castration-resistant prostate cancer are burdened with BRCA1 BRCA2 gene mutations, which imply a high risk of disease progression. The presence of mutations means a poorer response to standard treatment, as well as a high risk of disease progression and death. Therefore, it is important to correctly identify BRCA mutations with modern diagnostics and to intensify treatment early with molecularly targeted drugs.

- Genetic testing in prostate cancer patients is not available from the oncology clinic. For urologists and radiation therapists, this information is important, because we have a wide range of options even when treating localized disease - from active surveillance to some form of radiation therapy to radical prostatectomy. Knowledge of the presence of the mutation allows us to refer the patient earlier for radical treatment, which can prevent the generalization of the disease," pointed out Dr. Iwona Skoneczna, head of the Chemotherapy Department at the Grochowski Hospital in Warsaw. Molecular testing, especially diagnosis of BRCA1 and BRCA2 gene mutations, plays a key role in the treatment of prostate cancer. According to expert recommendations, early performance of these tests as early as the urologist's tissue collection stage is crucial for identifying patients who may benefit from targeted therapy. This is particularly important for aggressive forms of prostate cancer, where targeted therapy can provide significant clinical benefit. A way to intensify treatment early is to use a combination of a molecularly targeted drug (PARP inhibitor) with a new hormonal drug (e.g., abiraterone) to extend the time to disease progression and overall survival of patients. Recently, new therapeutic regimens (association of a PARP inhibitor with a new hormonal drug) have emerged to offset the risks associated with the presence of BRCA mutations, but are not yet reimbursed.

An analysis of available data and new studies suggests that early intensification of treatment by using a combination of an NHT inhibitor with a PARP inhibitor may be key to achieving longer and deeper therapeutic responses in patients with advanced prostate cancer. Studies indicate that some patients will not receive the PARP inhibitor in the next line of therapy, underscoring the importance of early treatment intensification.

- We have more and more data that the combination of these drugs is beneficial for patients, not only for those with mutations, but even across the entire patient population," Dr. Iwona Skoneczna noted.