Οικονομική Αξιολόγηση στην σκλήρυνση κατά πλάκας και την νόσο Πάρκινσνον

11ο Θερινό Συμπόσιο Νευρολογίας Οικονομική Αξιολόγηση στην σκλήρυνση κατά πλάκας και την νόσο Πάρκινσνον Nίκος Μανιαδάκης BSc (Athens), MSc (York), PhD (Warwick) Καθηγητής & Διευθυντής Τομέας Οργάνωσης και Διοίκησης Υπηρεσιών Υγείας Αναπληρωτής Κοσμήτορας Εθνική Σχολή Δημόσιας Υγείας

Δομή Εισαγωγή Αξιολόγηση οικονομικού φορτίου Αξιολόγηση κόστους-οφέλους θεραπείας Η περίπτωση της Ελλάδας Συμπεράσματα

Υγεία και Πλούτος «Ένας σοφός άνθρωπος πρέπει να θεωρεί ότι η υγεία είναι η μεγαλύτερη ανθρώπινη ευλογία, και να μάθει πώς μπορεί με την ίδια του τη σκέψη, να αντλεί όφελος από την ασθένειά του» Ιπποκράτης

Η σχέση ανάμεσα στην φροντίδα, την υγεία και την οικονομία Health care is a crucial investment to promote health and economic growth SOURCE: The contribution of health to the economy in the European Union, Suhrcke, McKee for the European Commission, DG Sanco (2005)

Υγεία και οικονομική ανάπτυξη

There is substantial evidence suggesting that "healthier is wealthier", i.e. that good health positively affects economic growth through a number of channels Good health improves the population's ability to work, increasing individual and aggregate labour productivity. Good health affects not only the labour supply of the ill and disabled but also of those who live with and take care of them. Good health is good for better educational attainment, which, in turn, is positively related to income, both at individual societal level. The evidence that good health positively affects the welfare of both individuals and societies is often put forward as an argument for considering health expenditure as a driver of economic growth and as such as an investment rather than as a cost. The health sector employs a significant and growing number of people of diverse skill and qualifications and creates demand for a number of industries. These industries are often associated with frontline knowledge, research and innovation and the development of high-tech products, and are recognised as drivers of economic growth.

Sustainable Health Systems Visions, Strategies, Critical Uncertainties and Scenarios. January 2013 ψηλότερες προσδοκίες Αυξανόμενη ζήτηση Σπατάλες Αύξηση δαπανών

Source: The 2009 Ageing Report: economic and budgetary projections for the EU-27 Member States (2008-2060). The European Commission (DG ECFIN) and the Economic Policy Committee (AWG)ISBN 978-92-79-11363-9. DOI 10.2765/80301. European Communities, 2009

A Significant Technological Effect Drugs Devices Equipment E health Source: Boston Consulting Group

Median Survival Increase in First Line Therapy of Metastatic Colorectal Cancer 1* 2* 3 4 5 2* 4 +91,2% 1* 6* 5 7 8 *KRAS Wt Median Survival mcrc (months) 1.Siena S, et al. ASCO-GI 2010. 2.Van Cutsem E, et al. ASCO-GI 2010; 3.Falcone A, et al. JCO 2007; 4.Saltz LB, et al. JCO 2008; 5Hurwitz HI, et al. NEJM 2004; 6. Maughan T. et al. ASCO GI 2010 7.De Gramont A, et al. JCO 2000; 8.Saltz LB, et al. NEJM 2000; 15

*2 in Survival reguires *466 in Therapy Cost!!

1. Schadendorf D, et al. Pooled analysis of long-term survival data from phase II and phase III trials of ipilimumab in metastatic or locally advanced, unresectable melanoma. Presented at: European Cancer Congress 2013 (ECCO-ESMO-ESTRO); 27- Sep 1 Oct, 2013; Amsterdam, The Netherlands. Abstract 24.

Empirical analysis shows that proper policies may aid HC systems to deliver same outcome at less cost Potential savings represent the difference between a no-reform scenario and a scenario where countries would become as efficient as the best performing countries Source: Joumard, Isabelle. 2010. Health Care Systems: Getting More Value for Money. No. 2. OECD Economics Department Policy Notes. OECD. http://www.oecd.org/eco/growth/46508904.pdf. 2-Oct-2013 European Health Policy Forum Gastein 20

There is competition for resources

Value based health care is emerging

Μορφές οικονομικής ανάλυσης και αξιολόγησης στην Υγεία ΟΙΚΟΝΟΜΙΚΟ ΦΟΡΤΙΟ ΤΗΣ ΑΣΘΕΝΕΙΑΣ ΚΟΣΤΟΣ ΤΗΣ ΘΕΡΑΠΕΙΑΣ ΣΧΕΣΗ ΚΟΣΤΟΥΣ ΟΦΕΛΟΥΣ ΤΗΣ ΘΕΡΑΠΕΙΑΣ ΕΠΙΠΤΩΣΕΙΣ ΤΗΣ ΘΕΡΑΠΕΙΑΣ ΣΤΟΝ ΠΡΟΥΠΟΛΟΓΙΣΜΟ Για να αποφασίσουμε που να επενδύσουμε τα χρήματα που διαθέτουμε για την υγεία; στην καρδιολογία, στην ογκολογία, στην ψυχιατρική? Για να ξέρουμε πόσο στοιχίζει πραγματικά, και τις επιπτώσεις έχει στο σύστημα υγείας και ασφάλισης; ένα φάρμακο π.χ. μπορεί να στοιχίζει, αλλά μπορεί να μειώνει την νοσηλεία ή την χρήση άλλων φαρμάκων Για να ξέρουμε ένα αξίζει να επενδύσουμε στο φάρμακο, να κάνουμε επιλογές ανάμεσα σε εναλλακτικά φάρμακα, και να βελτιστοποιούμε τις συνθήκες χρήσεως τους Για να εκτιμήσουμε τις επιπτώσεις της επιλογής συγκεκριμένων φαρμάκων στον συνολικό προϋπολογισμό μας, ανάλογα με τα διάφορα σενάρια διείσδυσης του

Paying more for more benefit Cost Benefit Life years Source: adapted from Prof. Matthias Graf von der Schulengurg

Paying based on affordability and willingness to pay

DALYs Western Europe

Western Europe - DALYs Source: Institute for Health Metrics and Evaluation, http://www.healthdata.org

Source: Institute for Health Metrics and Evaluation, http://www.healthdata.org Western Europe - YLD

Source: Institute for Health Metrics and Evaluation, http://www.healthdata.org Greece - YLD

Οι νόσοι του εγκεφάλου προκαλούν σημαντικό οικονομικό φορτίο

NICE Multiple Sclerosis Therapy Alemtuzumab Daclizumab Dimethyl fumarate Natalizumab Fingolimod Teriflunomide Beta interferon Glatiramer acetate Recommendation Is recommended in its marketing authorisation for adults with active relapsing remitting multiple sclerosis Is recommended in adults, if the person has active relapsing remitting multiple sclerosis, previously treated with disease modifying therapy or rapidly evolving severe relapsing-remitting ms and alemtuzumab is contraindicated or unsuitable Is recommended in adults with active relapsing remitting multiple sclerosis or rapidly evolving severe relapsing remitting multiple sclerosis Is recommended in its marketing authorisation for adults with rapidly evolving severe relapsing remitting multiple sclerosis Is recommended for adults with highly active relapsing remitting multiple sclerosis only if: they have an unchanged or increased relapse rate or ongoing severe relapses compared with the previous year despite treatment with beta interferon, and the manufacturer provides fingolimod with the discount agreed as part of the patient access scheme Is recommended in its marketing authorisation for adults with active relapsing remitting multiple sclerosis that isn t highly active or rapidly evolving severe relapsing remitting multiple sclerosis Are not recommended on the basis of their clinical effectiveness and cost-effectiveness

NICE Multiple Sclerosis Therapy Deep brain stimulation for tremor and dystonia (excluding Parkinson's disease Functional electrical stimulation (FES) for drop foot of central neurological origin Recommendation Current evidence appears adequate to support the use of this procedure, provided that the normal arrangements are in place for consent, audit and clinical governance. Patient selection and management should be carried out in the context of a multidisciplinary team specialising in the long-term care of patients with movement disorders Current evidence appears adequate to support the use of this procedure provided that normal arrangements are in place for clinical governance, consent and audit. Patient selection for implantable FES for drop foot of central neurological origin should involve a multidisciplinary team specialising in rehabilitation. Further publication on the efficacy of FES would be useful, specifically including patientreported outcomes, such as quality of life and activities of daily living, and these outcomes should be examined in different ethnic and socioeconomic groups. Percutaneous venoplasty for chronic cerebrospinal venous insufficiency (CCSVI) Current evidence for multiple sclerosis (MS) is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. NICE encourages further research on percutaneous venoplasty for CCSVI for MS, in the form of robust controlled clinical trials. Studies should clearly define selection criteria and patient characteristics. They should also clearly define technical success which may include measurement of pressure gradients across treated vein segments before and after venoplasty. Outcomes should include clinical and quality of life measures.

NICE Parkinson s Therapy Deep brain stimulation for Parkinson's disease Recommendation Current evidence appears adequate to support the use of the procedure, provided that normal arrangements are in place for consent, audit and clinical governance. It is recommended that patient selection should be made with the involvement of a multidisciplinary team, and that patients should be offered the procedure only when their disease has become refractory to best medical treatment. Subthalamotomy for Parkinson's disease Current evidence does not appear adequate to support the use of this procedure without special arrangements for consent and for audit or research.

Greece: Disease Rankings Global Burden of Disease Study 2015. Institute for Health Metrics and Evaluation

Επίπτωσης οικονομικής κρίση στην υγεία

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e5142 (Published 14 August 2012)Cite this as: BMJ 2012;345:e5142

Συμπεράσματα Οι παθήσεις του εγκεφάλου προκαλούν μεγάλο οικονομικό και κοινωνικό φορτίο για τα Συστήματα Υγείας και την Κοινωνία Ειδικότερα σκλήρυνση και η νόσος του πάρκινσον σχετίζονται με υψηλό κόστος ανά ασθενή, μεγάλο μέρος του οποίου είναι έμμεσο και αυξάνεται με την βαρύτητα της νόσου και διαχρονικά Η οικονομική κρίση επηρεάζει την γενικότερη και ειδικότερα την ψυχική μας υγεία και τις υπηρεσίες υγείας και στην Ελλάδα θα πρέπει να οργανωθεί το σύστημα υγείας καλύτερα Οικονομική αξιολόγηση των θεραπειών στην πολλαπλή σκλήρυνση και στη νόσο πάρκινσον δείχνουν ότι αποτελούν ελκυστική χρήση των πόρων στις περισσότερες περιπτώσεις και υπό συνθήκες

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