Burden of Copd in Romania Florin Dumitru Mihaltan
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BURDEN OF COPD IN ROMANIA FLORIN DUMITRU MIHALTAN RUXANDRA ULMEANU IRINA STRIMBU NATIONAL INSTITUTE OF PNEUMOLOGY “MARIUS NASTA” BUCHAREST - ROMANIA SUMMARY INTRODUCTION EPIDEMIOLOGY STUDIES RISK FACTORS COMPLIANCE TO GUIDELINES? EXACERBATIONS AND COSTS OF COPD IN ROMANIA THERAPY IN AMBULATORY REIMBURSEMENT OF THE COPD TREATMENT IN ROMANIA CONCLUSIONS FUTURE DEMANS INTRODUCTION Why Romania has his own problem • Prevalence study? • Risk factors ? • Compliance to guidelines? • Cost of disease and exacerbations? • The hospitalised and ambulatory problems • Reimbursement of medication? EPIDEMIOLOGY STUDIES Morbidity and mortality in comparison with other countries COPD PREVALENCE IN ROMANIA IN 1998 2,30% FEMALE 4,60% MALE Du ţu St, Păun G. – Prevalen ţa simptomelor respiratorii, a astmului bron şic şi bron şitei cronice (simple şi obstructive) într-un eşantion reprezentativ de popula ţie adult ă rural ă. Pneumoftiziologia 1998, Jul-Sep, 47(3): 151-160. ROMANIA - COPD INCIDENCE – 2004 - GP MISSDIAGNOSIS 2 5 0 0 0 21485 2 0 0 0 0 12821 15 0 0 0 10 0 0 0 4918 5 0 0 0 6 0 Total 0-14 15-64 ≥65 Source: Centrul de Statistica Medicala si Documentare Medicala Registrul National de boli pulmonare cronice 2005,fara numar pagina ROMANIA - COPD INCIDENCE – 2004 - SPECIALISTS DIAGNOSIS -also internal medicin - 27212 30000 25000 16860 20000 15000 10352 10000 5000 0 0 Total 0-14 15-64 ≥65 Source: Centrul de Statistica Medicala si Documentare Medicala Registrul National de boli pulmonare cronice 2005,fara numar pagina ROMANIA – MORTALITY RATE Chronic Obstructive Diseases - 1998 5,00% OOO FEMALE 20,00% OOO MALE Du ţu St, Păun G. – Prevalen ţa simptomelor respiratorii, a astmului bron şic şi bron şitei cronice (simple şi obstructive) într-un eşantion reprezentativ de popula ţie adult ă rural ă. Pneumoftiziologia 1998, Jul-Sep, 47(3): 151-160. RISK FACTORS SMOKING HABITS ROMANIA 2006 COPD Exacerbation – Hospitalisation Smoking Habits of the patients 12% 21% Unsmokers Ex/smokers Smokers 28% Not mention 39% Average of 20 package / year Irina Strambu: “BPOC – Astm bronsic: abord terapeutic si costuri in Romania”, 2006, Teza de doctorat, UMF “Carol Davila”, Bucuresti • More Smoker as in EU • Quitters less as in EU Smoking Fuma ţi Fuma ţi Priza ţi You tried Have Alt Withou cigarette ţig ări pe pip ă sau to you răspuns t s from care le sau mesteca ţi renounce ever (spontan) answer packs face ţi trabuc tutun smoke singur RO 31% 0 - - 11% 57% 0 15% Are you smoking at home? RO: 91% yes Second place in EU after Hungary Compliance to guidelines? COPD- WHAT IS PRESCRIBED IN EUROPE? GREAT BRITAIN ITALIE BETA ADREN. 40% • METILXANTINS -40% INHAL CORTICOIDS 20% • ANTIB.AND ANTICOUGH- ANTICOLINERG. < 20% 25% 70% from the whole • BETA 2 ADRENERGICS < 20% prescription GERMANY, AUSTRIA • ANTICOUGH SI MUCOLITICS 35% • METILXANTINE 20% M. Rudolf: The Reality of Drug Use in COPD. The European Perspective Chest 2000;117;29-32 COPD- WHAT IS PRESCRIBED IN ROMANIA ? QUESTIONNAIRE FOR GP, PNEUMOLOGIST, INTERNISTS IN 1998 (308 PATIENTS) WHAT THEY PREFER AS TREATMENT FOR COPD ? V. Golli, Ileana Băzăvan, Andreea-Loredana Golli - Sondaj asupra măsurilor preconizate în BPOC. Pneumoftiziologia 1998, vol. XLVII, nr. 2, 83-88 WHAT MEDICATION IS PRESCRIBED IN ROMANIA - 1998? THEOPHYLLINE - most part of prescription - 1/3 parenteral I.V. !! BETA 2 ADRENERGICS INHALING - Majority of pneumologists - ½ of internists - few GP INHALING CORTICOTHERPY – Majority of pneumologists SYSTEMIC CORTICOID – Internists, GP V. Golli, Ileana Băzăvan, Andreea-Loredana Golli - Sondaj asupra măsurilor preconizate în BPOC. Pneumoftiziologia 1998, vol. XLVII, nr. 2, 83-88 WHAT ARE THE PRESCRIPTIONS IN THE HOSPITAL -2004 Simpatomimetice cu acţiune scurtă 83% Teofiline orale (retard) 81% Antibiotice 73% Corticoizi inhalatori 72% Fluidifiante de mucus 66% Corticoizi sistemici 64% Corticoizi oral 42% Corticoizi parenteral 39% Anticolinergice 30% Simpatomimetice cu acţiune lungă 16% Teofiline i.v. 6% 4% Antitusive 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Irina Strambu: “BPOC – Astm bronsic: abord terapeutic si costuri in Romania”, 2006, Teza de doctorat, UMF “Carol Davila”, Bucuresti EXACERBATIONS AND COSTS OF COPD IN ROMANIA Year Country COSTS Source 1154 ₤ (2300$)/PATIENT/year 1996 UK 47,5% Drugs 24% Oxyg. 18% Hospital National Health Service Executive. Burdens of disease: a discussion document. Leeds, United Kingdom; Department of 10% GM Health, 1996 Rutten-Van Mo¨ lken MP et al. Current and future medical cost 1999 HOLAND 813$/PATIENT of asthma and chronic obstructive pulmonary disease in the Netherlands. Respiratory Medicine, 1999, 93 (11): 779–787. 1876 €/PATIENT 2003 SPAIN 43% Hospital 40% Drugs Miravitlles M, Murio C, Guerrero T, Gisbert R. - Costs of chronic 15% Diagnosis Tests bronchitis and COPD: a 1-year follow-up study. Chest. 2003 Mar;123(3):784-91. 4366 €/PATIENT 41% MONITORING 2004 FRANCE 25% COMPLICATION Scope study - B. Detournay, C. Pribil, M. Fournier, B. Housset, 34% COMORBIDITIES G. Huchon, D. Huas, P. Godard, C. Voinet, I. Chanal, Colette Jourdanne, I. Durand-Zaleski, the SCOPE Group - The SCOPE 1/3 Hospital Study: Health-Care Consumption Related to Patients with 1/3 DRUGS Chronic Obstructive Pulmonary Disease in France. Value in Health Volume 7 Issue 2 Page 168 - March 2004 ROMANIA - COPD – 2004 - HOSPITALIZATION 25000 22912 BPOC 18714 20000 TOTAL: 75093 MALE: 49936 16434 15000 11892 10000 3064 5000 134 179 151 239 523 851 0 <1 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 >85 Source: Centrul de Statistica Medicala si Documentare Medicala Registrul National de boli pulmonare cronice 2005,fara numar pagina HEALTH CARE COSTS OF EACH OF THE ABOVE 4 SMOKING RELATED DISEASES BY AGE AND SEX-PER PATIENT ROMANIA - 2004 1576.3 1600 1530.2 1550 1500 1450 1400 1337.7 1336.1 1350 1300 1250 1200 Cancer Boli cerebro- BPOC Cardiopatii bronhopulmonar vasculare ischemice Source: Centrul de Calcul si Statistica Sanitara –Bucuresti Anuar de Statistica Sanitara 2005, Cheltuieli sanitare, pag.263 COPD DRUGS – SALES-UNITS – ROMANIA 2006 VENTOLIN INHALER 704114 SYMBICORT 12083 12345 SPIRIVA SINGULAIR 155558 SEREVENT 7261 SERETIDE 293448 FLIXOTIDE 34669 EURESPAL 856840 BECOTIDE+BECLOFORTE 111461 4884336 ALL XANTHINES 0 500000 1000000 1500000 2000000 2500000 3000000 3500000 4000000 4500000 5000000 COPD COSTS IN ROMANIA EVALUATION OF EXACERBATIONS COSTS IN A HOSPITAL OF SUPERIOR LEVEL AS THE NATIONAL INSTITUTE OF PNEUMOLOGY “MARIUS NASTA” RETROSPECTIVE STUDY JAN – SEPT. 2002 181 PACIENTS DIAGNOSIS COPD “EXACERBATION” Irina Strambu: “BPOC – Astm bronsic: abord terapeutic si costuri in Romania”, 2006, Teza de doctorat, UMF “Carol Davila”, Bucuresti 2004 COPD EXACERBATION – HOSPITALISATION OVER 75% ARE SMOKERS FEMALE 27,5% 72,5% MALE Irina Strambu: “BPOC – Astm bronsic: abord terapeutic si costuri in Romania”, 2006, Teza de doctorat, UMF “Carol Davila”, Bucuresti 2004 COPD EXACERBATION – HOSPITALISATION Distributed by urban or rural areal RURAL URBAN 48% 52% Irina Strambu: “BPOC – Astm bronsic: abord terapeutic si costuri in Romania”, 2006, Teza de doctorat, UMF “Carol Davila”, Bucuresti 2004 COPD EXACERBATION – HOSPITALISATION COPD PREVALENCE IS HIGHER IN TOWNS RURAL AREA ARE “COMPENSATING” There is an important pressure to hospitalized the patients for diagnosis and investigation with a reduced accessibility or inaccessible in ambulatory Irina Strambu: “BPOC – Astm bronsic: abord terapeutic si costuri in Romania”, 2006, Teza de doctorat, UMF “Carol Davila”, Bucuresti 2004 COPD EXACERBATION – HOSPITALISATION Duration of hospitalisation 25 ZILE DE SPITALIZARE 21,12 17,18 20 15,84 15,6 14,94 15 10 5 0 STADIUL I STADIUL II STADIUL III STADIUL IV MEDIA STAGE I-III Similar stay period STAGE IV Long period of hospitalization Irina Strambu: “BPOC – Astm bronsic: abord terapeutic si costuri in Romania”, 2006, Teza de doctorat, UMF “Carol Davila”, Bucuresti HEALTH CARE COSTS OF EACH OF THE ABOVE 4 SMOKING RELATED DISEASES BY AGE AND SEX ROMANIA – 2004-Average of hospitalisation days Media zilelor de spitalizare 9.91 10 9.62 9.5 9 8.41 8.4 8.5 8 7.5 Cancer Boli cerebro- BPOC Cardiopatii bronhopulmonar vasculare ischemice Source: Centrul de Calcul si Statistica Sanitara –Bucuresti Anuar de Statistica Sanitara 2005, Cheltuieli sanitare, pag.263 2004 AVERAGE HOSPITALIZATION PERIOD : 17 DAYS Significant longer as in US < 6 days SPAIN - 11 days COPD – MORE SEVERE - 42% STAGE IV LONGER PERIOD OF HOSPITALIZATION (21 DAYS) • SEVERE INFECTIONS PATHOGENS • OROTRACHEAL INTUBATED CASES • INVAZIVE MECHANICAL VENTILATION • CPAP 15 DAYS EVEN TO PATIENTS WITH EASY STAGING – WHY? Irina Strambu: “BPOC – Astm bronsic: abord terapeutic si costuri in Romania”, 2006, Teza de doctorat, UMF “Carol Davila”, Bucuresti 2004 COPD EXACERBATION – HOSPITALISATION Staging of the patients 45% 40% 35% 30% 25% 20% 15% 10% 5% 6% 24% 28% 42% 0% STADIUL I STADIUL II STADIUL III STADIUL IV BLOOD GAS ANALYSES - 37% RESPIRATORY FAILURE Irina Strambu: “BPOC – Astm bronsic: abord terapeutic si costuri in Romania”, 2006, Teza de doctorat, UMF “Carol Davila”, Bucuresti MOST PART OF HOSPITALIZED PATIENTS ARE IN STAGE III AND IV “THE OTHERS” “ARE CARRING ” THE DISEASE UNDIAGNOSED 200 180 160 140 120 100 80 60 40 70% 20 0 181 PACIENTI STADII III+IV Irina Strambu: “BPOC – Astm bronsic: abord terapeutic si costuri in Romania”, 2006, Teza de doctorat, UMF “Carol Davila”, Bucuresti 2004 COPD EXACERBATION – HOSPITALIZED CO-MORBIDITIES 45% 40% 35% 30% 25% 20% 15% 10% 5% 43% 16% 21% 20% 0% CARDIOVASCULAR DIABET ZAHARAT SECHELE TBC BROSIECTAZII Irina Strambu: “BPOC – Astm