Overview and Analysis of the Cost of Drug Programs in Poland: Public Payer Expenditures and Coverage of Cancer and Non-Neoplastic Diseases Related Drug Therapies from 2015-2018 Years.

BACKGROUND: In Poland drug programmes developed by the Minister of Health and financed by the National Health Fund are special reimbursement frameworks of innovative, expensive, and mostly hospital based medical products used for a small number of patients. RESEARCH DESIGN: The research presented in this paper is based on data analysis published by the National Health Fund in Poland. The analysis focused on estimating public payer expenditure on drugs available within drug programmes from 2015 to 2018. RESULTS: In subsequent years, reimbursement of drugs used within drug programmes was associated with the National Health Fund budget expenditure of 635 mln USD, 755 mln USD, 854 mln USD, and 921 mln USD, respectively. Reimbursement of oncology drug programmes constituted 48.1%, 42.5%, 47.1%, and 52.4% and were approximately 305, 312, 402, 483 mln USD, whereas values of non-oncology drug programmes were approximately 330, 434, 452, and 438 mln USD which constituted 51.9%, 57.5%, 52.9%, and 47.6% respectively. CONCLUSION: Despite the fact that the expenditure on drug programs in Poland are increasing every year, they undoubtedly improve the patient's access to the most innovative oncological and nononcological therapies in the Polish healthcare system.

The direct and indirect costs of epilepsy in Poland estimates for 2014-2016 years.

BACKGROUND: According to the current data, around 1% of the Poland population have epilepsy, which comprises about 400,000 people. This group of patients requires life-long therapy including both drug therapy and hospitalization. The character of the epilepsy has a significant impact on the expenses borne by individual patients, and the prevalence of the disease has a significant impact on the health care system. METHODS: This article aims to measure the direct and indirect costs of epilepsy in Poland estimates for the years 2014-2016 (top-down approach). We use a modified human capital approach and a unique dataset provided by the number of Polish institutions including National Health Fund, Social Insurance Institution, and Central Statistical Office. RESULTS: Epilepsy burden in Poland is significant. In the years 2014-2016, the total direct cost of epilepsy amounted to, respectively, 355 mln PLN (84 mln EUR), 368 mln PLN (87 mln EUR), and 373 mln PLN (88 mln EUR), but the total indirect cost amounted to 1 bn PLN (239 mln EUR), 949 mln PLN (224 mln EUR), and 848 mln PLN (200 mln EUR). CONCLUSIONS: Direct and indirect costs of epilepsy can be a useful input for health technology analyses of drugs or economic impact assessments of public health programs.

Cost-effectiveness of radial vs. femoral approach in primary percutaneous coronary intervention in STEMI - Randomized, control trial.

INTRODUCTION AND OBJECTIVES: Primary percutaneous coronary intervention infarction became the preferred method of treatment for myocardial ST segment elevation. Improved safety was reported in transradial access (radial) compared to transfemoral access (femoral). The aim of this study was to compare the cost between the two access points in ST segment elevation myocardial infarction. METHODS: This is a subanalysis of the OCEAN RACE trial in which 103 myocardial infarction patients were randomized to either the radial (n=52) or femoral (n=51) groups. The clinical safety and efficacy were recorded during the hospital stay. The procedural metrics were meticulously logged, and costs were evaluated using the micro-cost method. The indirect costs were estimated using the human capital approach. RESULTS: Clinical success was numerically higher in the radial group (90.4 vs. 80.4%, p=0.123). There were no differences in major adverse cardiac events (9.6% vs. 11.8%, p=0.48) and death (2.0% vs. 6.0%, p=0.31). The average in-hospital cost per patient was 2,740 ± 1,092 EUR. The cost of therapeutic success was lower in the radial group at 3,060 EUR vs. 3,374 EUR. The indirect costs related to absence at work were 138 EUR per patient, which were lower in the radial group compared to the femoral group. CONCLUSIONS: The total in-hospital costs were similar between the study groups. The indirect costs were lower in the radial group. Introduction of radial access as the default approach in all centers may significantly reduce the overall financial burden from a social perspective.

Health outcomes and economic consequences of using angiotensin-converting enzyme inhibitors in comparison with angiotensin receptor blockers in the treatment of arterial hypertension in the contemporary Polish setting.

BACKGROUND: Arterial hypertension (AH) represents a public health problem in Poland, firstly due to the huge, still growing population of patients (10.45 million patients based on NATPOL 2011 and PolSenior Surveys), and secondly because of the substantial cost of reimbursement from the National Health Fund (NHF). The most commonly used drugs in the treatment of AH include angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), the latter being associated with significantly higher unit reimbursement cost. Recent meta-analyses of randomised, controlled trials indicate that there is no medical reason to favour ARBs over ACEIs in AH treatment. AIM: To assess the clinical benefit of using ACEIs instead of ARBs and to calculate the potential savings for the payer and patients associated with changing the treatment paradigm to preferential use of ACEIs. METHODS: The assessment of clinical consequences includes differences between ACEIs and ARBs in terms of average life expectancy and quality-adjusted life years (QALYs) gained. The impact of these drugs on general mortality was estimated based on the meta-analysis carried out by van Vark et al. in 2012. Patients' health-related quality of life was adjusted with Polish population utility norms derived for the EQ-5D-3L questionnaire and additionally for ACEI-induced cough-related utility decrease. Potential savings for the payer on a yearly basis were calculated for a hypothetical cohort of patients who are currently treated with ARBs and might be switched to ACEIs. The number of patients treated with ARBs and ACEIs was estimated based on NHF and IMS Health data. RESULTS: ACEIs were associated with a statistically significant 10% reduction in all-cause mortality, which results in extra life gained of 0.354 years (4.2 months) or an additional 0.201 QALY (2.4 months). Potential annual savings could amount to 112.0 million PLN (25.7 million EUR) and 10.5 million PLN (2.4 million EUR) for the public payer (NHF) and patients, respectively; and 1768 cardiovascular deaths per year could be prevented. CONCLUSIONS: Preferential use of ACEIs in comparison with ARBs in the treatment of AH is associated with substantial extension of life (including quality-adjusted life), reduction of cardiovascular deaths, and savings for the NHF and patients.

[Cost of lost productivity in pharmacoeconomics analysis. Part II. Survey in the expert group]. / Koszty utraconej produktywnosci w analizach farmakoekonomicznych. Czesc II. Badanie opinii w grupie ekspertów.

The aim of the survey was to collect data on practice and preferences of decision-makers and experts in health economics concerning the role of indirect costs in Poland. The questionnaire contained 18 questions covering the need for indirect costs calculation in economic evaluations and measures used to calculate indirect cost. Fifty four respondents related to health economics returned completed questionnaires. Mean age of respondents was 33,3 years; mean experience in health economics 4.7 years; 43% (23/54) of responders had non-economic background; 30% each were users and doers of health technology assessment reports. All (excluding one) responders indicated that indirect costs should be calculated in pharmacoeconomic studies. Twenty three (i.e., 43%) responders indicated human capital approach as the best method to estimate costs from societal perspective; friction cost method came second best 11%; 42% respondents had no opinion. The doers of economics evaluations pointed to GDP per capita (61%, 11/18), average salary (61%, 11/18), and costs of sick pay or injury benefit (61%, 11/18) as measures which could be used to value production losses. Indirect costs are considered important component of economic evaluations of healthcare interventions in Poland. The lack of widely accepted methods for indirect cost evaluation support further research.

[Cost of lost productivity in pharmacoeconomics analysis. Part I. A systematic review of the literature]. / Koszty utraconej produktywnosci w analizach farmakoekonomicznych. Czesc i. Przeglad systematyczny pismiennictwa.

The inclusion of indirect costs of illness in economic studies is still a subject of considerable debate. The aim of the systematic literature review was to present the Polish economic practice concerning indirect costs evaluation of healthcare interventions. MEDLINE, EMBASE, Cochrane Library and Polish Medical Bibliography (PBL) were searched. Cut-off dates were set to February and March 2009. The main specific keywords were 'indirect costs' or 'costs and cost analysis'. Nineteen studies fulfilled the inclusion criteria for this review, of a total of 2300 references. Seventeen out of 19 studies were cost of illness studies, 2 were economic analyses. Methods of indirect costs evaluation were all based on human capital approach. The work absenteeism unit time measure used to value productivity loss were average salary (9/19), Gross Domestic Product (GDP) per capita (7/19), Gross National Product per capita (1/19), GDP per active worker (1/19), sold production of industry per active worker (1/19). Mean indirect costs were ca. 58% of total costs (range: 16%-98%). In 5 studies transfer payments were added to productivity loss category. Indirect cost is rarely included in the economic analyses in Poland. Various methods of indirect costs calculation limit comparison between studies and support the need for development of robust and widely accepted methodology.

Self-assessed health status in Poland: EQ-5D findings from the Polish valuation study.

INTRODUCTION: There are no population norms currently available in Poland for any generic health-related quality of life (HRQoL) questionnaire for adults. OBJECTIVES: The aim of the study was to evaluate the health status of a representative sample of the general Polish population using the EQ-5D questionnaire. MATERIAL AND METHODS: Adult subjects who were visiting patients in 8 medical centers in Warsaw, Skierniewice, and Pulawy, were inter viewed during the Polish EQ-5D valuation study. Stratified quota sampling was used. The respondents completed the EQ-5D questionnaire and provided information on age, sex, marital status, education, employment, income, housing conditions, medical history, and smoking habits. The interviews were conducted between February and May 2008. RESULTS: The final sample (n = 317) was representative of the general Polish population with respect to age and sex. Moderate problems in at least 1 dimension of the HRQoL were reported by 57% of the respondents, while extreme problems by 4.7%. Pain or discomfort was reported by 40% of the respondents, anxiety or depression by 38%. Problems with mobility were reported by 16% of the respondents, with usual activities (work, school) by 13%, and with self-care by 3%. The mean state of health recorded on the visual analogue scale (VAS) was 81.6 +/-14.4 points. The mean VAS value decreased from 87 and 91 points in the youngest age group to 67 and 72 points in the oldest age group, in men and women, respectively. CONCLUSIONS: Pain and anxiety are commonly reported problems in the Polish population, especially by young women. EQ-5D is a valuable tool for studying health outcomes and differences in health status within the Polish population.

[Indirect costs in health technology assessment]. / Koszty posrednie w ocenie technologii medycznych.

In the health technology assessment it is crucial to define the perspective of the analysis. When the societal perspective is chosen it is necessary to include all the costs incurred by the society, also the costs of lost productivity resulting from absence of sick employees from work or their reduced efficiency at work. The aim of this article is to present the notion of indirect costs, their importance in health technology assessment and the methods of calculation. The economic literature has been reviewed for the state of knowledge on indirect costs. Three methods of calculation are described: human capital method, friction cost method or health state valuation. Indirect costs in Western European countries can amount to more than half of total costs attributed to the illness and its treatment. In the literature there is no consensus regarding the proper method of indirect costs calculation. It is necessary to conduct further theoretical and empirical research in the area of indirect costs and enhance discussion among Polish pharmacoeconomists.

Valuation of EQ-5D health states in Poland: first TTO-based social value set in Central and Eastern Europe.

OBJECTIVE: Currently, there is no EQ-5D value set for Poland. The primary objective of this study was to elicit EQ-5D Polish values using the time trade-off (TTO) method. METHODS: Face-to-face interviews with visitors of inpatients in eight medical centers in Warsaw, Skierniewice, and Pulawy were carried out by trained interviewers. Quota sampling was used to achieve a representative sample of the Polish population with regard to age and sex. Modified protocol from the Measurement and Value of Health study was used. Each respondent ranked 10 health states and valued 4 health states using the visual analog scale and 23 using the TTO. Mean and variance stability tests were performed to determine whether using a larger number of health states per respondent would yield credible results. Modeling included random effects and random parameters models. RESULTS: Between February and May 2008, 321 interviews were performed. Modeling based on 6777 valuations resulted in an additive model with all coefficients statistically significant, R(2) equal to 0.45, and value -0.523 for the worst possible health state. Means and variance did not differ significantly for states valued in the middle and at the end of the TTO exercise. CONCLUSIONS: This is the first EQ-5D value set based on TTO in Central and Eastern Europe so far. Because the values differ considerably from those elicited in Western European countries, its use should be recommended for studies in Poland. Increasing the number of health states that each respondent is asked to value using TTO seems feasible and justifiable.