Current status of epilepsy health care for adult patients from Central and Eastern European Union Countries—A survey of members of the Central Europe Epilepsy Experts Working Group

PurposeThe aim of this survey was to review and compare the current approaches to epilepsy management in Central and Eastern EU (CEEU) countries.MethodThe questionnaire was sent to ten invited experts from Bulgaria, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia, and Slovenia. It focused on the treatment of adults.ResultsThe number of neurologists and epilepsy reference centers is highly variable in CEEU countries. None of the analyzed states has a formal specialization in epileptology. No universal state-approved criteria for reference centers exist in Czech Republic, Estonia, Hungary, Latvia, and Slovenia. Generally, the protocols for epilepsy treatment in CEEU countries, including drug-resistant epilepsy, are in accordance with international guidelines; however, most countries have their own national standards of care and some have local clinical guidelines. Also, the reimbursement systems for antiepileptic drugs in CEEU countries are highly variable. Seven countries have epilepsy surgery centers. The costs of epilepsy surgeries are fully reimbursed, procedures performed abroad may also be covered. The length of time spent on waiting lists for surgery following the completion of preoperative investigations varies from two weeks to three years. The fraction of patients who qualified and were operated on within 12 months ranges from 20% to 100%.ConclusionThe lack of unified procedures pertaining to the evaluation and therapy of epilepsy is reflected by marked differences in access to treatment modalities for patients from CEEU countries.     

The Pharmaceutical Pricing and Reimbursement Information (PPRI) initiative—Experiences from engaging with pharmaceutical policy makers

ObjectiveTo present the Pharmaceutical Pricing and Reimbursement Information (PPRI) initiative, as an illustrative example of an engagement with policy makers in the field of pharmaceutical pricing and reimbursement.MethodsThe paper is based on internal assessments and feed-back from the involved policy makers as well as an external evaluation.ResultsPPRI is a network of around 70 institutions, mainly public authorities for pharmaceutical pricing and reimbursement information from 41, mostly European, countries. It evolved from a European Commission co-funded project in 2005–2007 into a self-funded Member States borne initiative. The first years of PPRI were characterized by trust-building and developing a joint understanding and language. In the initial stages, country reports, so-called ‘Pharma Profiles’, written by policy makers, were among the most important deliverables. In the course of time, ad-hoc queries which require immediate, brief and precise answers have gained importance. PPRI is predominantly an internal network for and with policy makers; it is not a policy-making body.ConclusionsAfter nearly one decade of existence, the PPRI network appears to be a sustainable network. Policy makers are committed to provide and share data and to contribute to the network as they have an added value for their daily work from access to evidence and the exchange of information and experience with fellow colleagues from other countries. The change in organisation from a research project to an independent networking initiative offers flexibility to react quickly to current challenges, but implies limited funding for the research agenda.     

Factors associated with 2-year persistence in fully non reimbursed lipid-lowering treatments

Objective

to evaluate the main factors associated with long-term persistence in fully paid lipid-lowering treatment.

Methods

We selected 628 moderately hypercholesterolemic subjects (M: 307; F: 311, mean age 59 ± 9 years old), to whom we firstly prescribed a statin (N. 397) or different kinds of lipid-lowering nutraceuticals (N. 231). Then, depending on their will, patients took brand statin (N. 194) or generic statins (N. 203).

Results

The main determinants of long-term persistence in therapy are female sex (OR 1.21, 95%CI 1.08–1.42), family history of early cardiovascular disease (OR 1.31, 95%CI 1.13–1.49), baseline LDL-C (OR 1.19, 95%CI 1.02–1.33) and treatment with nutraceuticals versus statins (OR 1.29, 95%CI 1.14–1.38). Persistence appears not to be influenced by patient's age, smoking habit, adverse events during treatment, and estimated cardiovascular risk.

Conclusion

Among self-paying patients with mild hyperlipidemia, medication persistence is highest among those taking nutraceuticals, followed by brand statins, followed by generic statins.     

我国药品不良反应责任保险的构建

目的:探索适合我国国情的药品不良反应(ADR)补偿机制。方法:结合我国实际,从保险行业、医药企业的发展以及ADR自身的发生特点等方面评价在我国将保险机制用于ADR补偿的可行性,并对ADR责任险的构建、运作提出建议。结果与结论:ADR责任险有利于保障患者的生命健康权益、解决医疗纠纷和促进医药企业的发展,并有利于促进ADR的上报和管理工作。而费率厘定、国家政策支持和ADR监测网络的完善是当前推行ADR责任险需要解决的问题。     

Funding processes for new vaccines: the need for greater understanding of the economic issues

Aim  Given the changing landscape for the economics of vaccines, this article discusses the nature of economic assessments, the criteria being applied by decision-makers, the available evidence on the cost-effectiveness of the newer vaccines and the methodological and policy issues involved. Subjects and methods  We examine the nature of economic assessments, recent evidence on the cost-effectiveness of vaccines as well as the methodological and political issues arising as a consequence of evaluating vaccination programmes from an economic point of view. Results  Economic evaluations of vaccination look at (1) different schedules and implementation of a vaccine in national programmes; (2) benefits for high-risk individuals as versus entire populations; (3) healthcare system costs and societal costs incurred as a result of vaccination programmes versus treating disease; (4) life years gained and quality-adjusted life years. Cost-effectiveness studies of vaccination range considerably in the ratios produced owing to the wide variation of vaccination programmes and differing target populations. Nevertheless, vaccination programmes with newer or less widely used vaccines such as as pneumococcal, meningococcal, hepatitis A and influenza vaccines have consistently demonstrated their cost-effectiveness. In practice, however, implementation of vaccination programmes generally precedes the demonstration of their cost-effectiveness Conclusion  In the face of growing pressure on health-care resources, vaccines–as other health interventions and products–will have increasingly to demonstrate their cost-effectiveness. This poses particular challenges given the specificity of vaccination both as an individual and collective health intervention.     

社区卫生服务定价与补偿机制研究(四)

为了制定适当的社区卫生服务价格，对社区卫生服务进行合理的补偿，本文在对4省12市46个社区卫生服务中心(或站)的项目成本进行测算的基础上，应用标准成本计算方法得出各项服务的建议价格对社区卫生服务政府补偿额进行了测算，提出了社区卫生服务补偿的政策建议。     

Severity and risk adjusting relating to obstetric outcomes, DRG assignment, and reimbursement

Obstetric risk has important implications for reporting and benchmarking quality in today's managed health care environment. Administrative data, including diagnosis related group (DRG) information collected by hospitals, is used by payers and governmental groups for reimbursement, monitoring quality, and setting financial rates. Obstetric conditions that affect the patient experience are coded but do not often contribute to the overall DRG assignment. This strategy, therefore, may provide comparisons that are misleading to consumers and payers. Additionally, financial rates often do not provide adequate reimbursement for the cost incurred in caring for high-risk patients. Finally, risk prediction strategies have historically been used to both identify vulnerable patients for early management and make more equitable comparisons of groups of patients.     

Osteoporosis care at risk in the United States

Osteoporotic fractures are associated with significant morbidity, mortality, and healthcare expenses. The United States (US) Surgeon General has described osteoporosis as a major public health concern that is underdiagnosed and undertreated. US federal agencies have established funding for bone density testing and put methodologies in place to monitor physician performance in the care of patients with osteoporosis. The US Centers for Medicare and Medicaid Services (CMS) has established bone density testing as a key preventive medical service and encouraged patients to have this test when first enrolling in Medicare. However, recent CMS actions have reduced reimbursement for dual-energy X-ray absorptiometry (DXA) to levels that are below the cost of providing this service at many facilities. As a consequence, it is likely that the number of DXA facilities in the US will decrease, thereby limiting patient access to an important diagnostic service and resulting in fewer patients being diagnosed and treated to reduce fracture risk. Unless there is a reversal of continuing reimbursement cuts for DXA, it is projected that future fracture rates will increase; the cost to Medicare for fracture-related care will be far greater than the savings in the cost of DXA services and medications to reduce fracture risk.