Practice of prescribing antipsychotics in schizophrenia during 2013-2018 based on data from the National Health Fund. / Praktyka preskrypcyjna w zakresie leków przeciwpsychotycznych w schizofrenii w latach 2013­2018 na podstawie danych Narodowego Funduszu Zdrowia.

AIM: The aim of the study was to analyse the prescribing pattern of antipsychotic drugs in patients with schizophrenia during the years 2013-2018. METHOD: Schizophrenia is analysed as one of the diseases with the highest rate of Disability-Adjusted Life Years - DALY. In this study, the unitary data of the National Health Fund (NFZ) reported in the years 2013-2018 were used. Adult patients were identified by their Personal Identification Number (PESEL), and the antipsychotics were identified by the European Article Number (EAN). The study included 209,334 adults who were diagnosed with F20 to F20.9 (according to ICD-10) and were prescribed at least one antipsychotic within a year. The active substances of prescribed antipsychotic medication have been divided into typical (first generation), atypical (second generation) and long-acting injectable antipsychotics (both first and second generation). The statistical analysis contains descriptive statistics for selected sections. A linear regression, one-way analysis of variance and t-test were used in the study. All statistical analyses were performed using R, version 3.6.1 and Microsoft Excel. RESULTS: In the years 2013-2018, the number of patients in the public sector diagnosed with schizophrenia increased by 4%. The largest increase was recorded among persons diagnosed with other schizophrenia (F20.8). In the analysed years, the number of patients who were prescribed second-generation oral antipsychotics increased significantly as well as the number of patients who were prescribed long-acting antipsychotics, especially the secondgeneration agents (risperidone LAI, olanzapine LAI). The most prescribed first-generation antipsychotics included: perazine, levomepromazine and haloperidol with a downward trend for each; and the most common second-generation drugs included: olanzapine, aripiprazole and quetiapine. A noteworthy finding was an extremely high increase in the frequency of prescribing haloperidol in the form of depot. CONCLUSIONS: Extending the study to include information on applied prescriptive practice in the private sector would provide a fuller picture of the studied phenomenon.

Analysis of psychiatric services for patients diagnosed with schizophrenia, reported to the National Health Fund in the years 2009-2018. / Analiza swiadczen psychiatrycznych dla pacjentów z rozpoznaniem schizofrenii sprawozdanych do Narodowego Funduszu Zdrowia w latach 2009­2018.

AIM.: Analysis of psychiatric services for patients diagnosed with schizophrenia, reported to the National Health Fund in the years 2009-2018. MATERIAL AND METHODS: Schizophrenia is analyzed as one of the diseases with the highest rate of Disability-Adjusted Life Years - DALY. In the study, the unitary data of the National Health Fund (NFZ) was used, reported in the years 2009-2018. Patients were identified by the Personal Identity Number (PESEL). The services for adults were analyzed, i.e., people who were at least 18 years old in the year when the services were discontinued, for whom the main disease was schizophrenia classified by ICD-10 codes: F20 to F20.9. Provided services were analyzed according to those specified in the ordinance of the President of the National Health Fund of June 28, 2019 - organizational units and billing product codes. RESULTS: Between 2009 and 2018, the number of patients diagnosed with schizophrenia treated in the public sector increased by 5%. In the analyzed years, the number of in-patients decreased by 9%, while the number of people using out-patient services and community treatment increased by 6%. In forensic psychiatry departments, a very high increase (by 212%) in the number of hospitalized patients was observed. In 2018, the average number of hospitalization days in a general psychiatric ward was 43, in the forensic ward 279. A very low percentage of patients (less than 3%) used day therapy. In out-patient treatment, the mainstay of therapy was a medical consultation; less than 10% of patients used other types of services. In 2018, an average of four visits/consultations per patient was reported. There has been a very high decrease in the number of patients (by 77%) using group therapy, family therapy and support. CONCLUSIONS: In 2009-2018, most patients diagnosed with schizophrenia in the public sector were treated using the traditional model of care: medical consultation and psychiatric hospitalization. It is advisable to reorganize the system - implementation and development of comprehensive care coordinated within the community care model. Extending the study with information from the non-public sector would give a full picture of system functioning and facilitate service needs estimation for this group of patients.

The Expiry of Humira® Market Exclusivity and the Entry of Adalimumab Biosimilars in Europe: An Overview of Pricing and National Policy Measures.

Background: From October 2018, adalimumab biosimilars could enter the European market. However, in some countries, such as Netherlands, high discounts reported for the originator product may have influenced biosimilar entry. Objectives: The aim of this paper is to provide a European overview of (list) prices of originator adalimumab, before and after loss of exclusivity; to report changes in the reimbursement status of adalimumab products; and discuss relevant policy measures. Methods: Experts in European countries received a survey consisting of three parts: 1) general financing/co-payment of medicines, 2) reimbursement status and prices of originator adalimumab, and availability of biosimilars, and 3) policy measures related to the use of adalimumab. Results: In May 2019, adalimumab biosimilars were available in 24 of the 30 countries surveyed. Following introduction of adalimumab biosimilars, a number of countries have made changes in relation to the reimbursement status of adalimumab products. Originator adalimumab list prices varied between countries by a factor of 2.8 before and 4.1 after loss of exclusivity. Overall, list prices of originator adalimumab decreased after loss of exclusivity, although for 13 countries list prices were unchanged. When reported, discounts/rebates on originator adalimumab after loss of exclusivity ranged from 0% to approximately 26% (Romania), 60% (Poland), 80% (Denmark, Italy, Norway), and 80-90% (Netherlands), leading to actual prices per pen or syringe between €412 (Finland) and €50 - €99 (Netherlands). To leverage competition following entry of biosimilar adalimumab, only a few countries adopted measures specifically for adalimumab in addition to general policies regarding biosimilars. In some countries, a strategy was implemented even before loss of exclusivity (Denmark, Scotland), while others did not report specific measures. Conclusion: Even though originator adalimumab is the highest selling product in the world, few countries have implemented specific policies and practices for (biosimilar) adalimumab. Countries with biosimilars on the market seem to have competition lowering list or actual prices. Reported discounts varied widely between countries.

[The costs of asthma in Poland in 2012]. / Koszty astmy w Polsce w 2012 roku.

UNLABELLED: The costs incurred for treatment of patients with asthma are an important part of health care in the budget of each country. The aim of the study was to evaluate the direct and indirect costs of asthma in Poland. The study was based on questionnaires completed by professionals--allergists and pneumonologists of 13 centers in which is conducted the diagnosis and treatment of asthma. MATERIALS AND METHODS: The costs of asthma were determined from the payer perspective (NHF) and from the perspective of social security (ZUS). The study evaluated the direct costs of one patient with asthma in 2012, and indirect costs, as measured by human capital or friction costs. The study involved 128 people, including 84 women and 44 men, mean age 51.04+/11.41 years. RESULTS: Among the most frequent concomitant diseases: allergic rhinitis (93.75%), gastro-oesophageal reflux (38.54%), urticaria (16.67%), atopic dermatitis (21.88%) were present. The average monthly cost of drugs in 2012 amounted to PLN 251.32 (61.29 EURO, 2012 EURO 1 year=4.1 PLN), including patient,s copayment amounted to PLN 65.48 (EUR 15.97). The study showed that the direct cost per patient was 3240,88 PLN (790,46 EURO,). The Indirect cost, calculated using the human capital was for an average PLN 17,579.18 (4287.6 EURO) per patient, and using the method of friction costs was PLN 5974.06 (EUR 1,457.2). CONCLUSIONS: Estimating the cost of the disease often depends on the adopted method of analysis, but in the study group, a significant advantage of the indirect costs of the disease was observed. The effectiveness of the treatment of asthma in Poland should also be aimed at reducing the indirect costs of illness.