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The Migraine management
in Poland
Jacek Rozniecki
Dept. of Neurology
Medical University in Lodz
Country description
•
•
Demography – 38 mln
Economy
– GDP (Gross Domestic Product)
–
1047 mld (bln) PLN = $385 mld (bln)
– GDP/capita = $10 200
– HC expenditure – 7% GDP/capita = $744
% of population in „new” EC countries
Health care system
• Description of key Regulatory/Reimbursement
assumptions
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–
–
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Free of charge (epilepsy*, PD, MG)
Lump (epilepsy**) (~$1)
30% reimbursement
50% reimbursement
Full charge
• Reimbursement/ triptans
– Full charge, no reimbursement
The role of Headache Society, Centers and
Specialists in migraine management
• Migraine Investigation Section of the Polish Neurological Society
• Polish Headache Society (in the structure of IHF)
– National congresses of PHS
– International conferences of PHS
– Pharmaco-meetings
• Treatment – „old guidlines“, „new guidlines“ - in progress
• Education
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–
–
–
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Headache Academy (for neurologists)
School of Headache (for GPs)
Headache courses for neurological specialty
Booklets for headache patients
Polish Headache Association
• Headache centers
– Lodz, Warsaw (3), Lublin, Poznan, Gdansk
The role of GPs
in migraine management
(supposed to be)
• Part in migraine treatment
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–
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First-line physician
Direct and fast contact
No need for diagnostics
No need for special conditions for routine patients care
No restrictions in terms of pharmaceuticals prescrptions
• Education
– Courses, and cooperation with a neurologist
• Guidelines
– The same as for neurologists
Headache care system
- view of GP
(The questionnaire prepared
by
Goril Bruvik Gravdahi
from
Norvegian National Headache Centre
Department of Neurology and Clinical
Neurophysiology
Trondheim, Norway)
Headache care system - view of GP
Headache care system - view of GP
Headache care system - view of GP
„Current“ situation in migraine therapy
Yearly worldwide units (millions)
Ergotamine-based compounds
NSAIDs, aspirin and others
Narcotic-based compounds
Triptans
1 800
1 600
1 400
1 200
1 000
800
600
400
200
0
1995
1996
1997
1998
1999
Guidetti V., MSD Symposium, Barcelona 2001
The migraine awareness among
population
•
Specialist
– Continuous education
– Easy access to up to date clinical research data, publications, EBM guidlines
– Participation in clinical and scientific meetings
•
GPs
– Continuous education
– Possibility of quick consultation with a neurologist and/or headache specialist
– Motivation of not sending a patient to a specialist
•
Patients
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Easy access to popular medical publications about common primary headaches
Access to simple self-evaluation/self-diagnostic tools
Patients‘ associations
Easy access to patients‘ internet forum
Enough of doctor‘s time for a patient
Patients‘ trust in their GP
The POSSIBILITIES how to IMPROVE it!
•
Key activities:
– Education, awareness and info for
– Neurologists
– GPs
– Patients
– Guidelines, EBM
– Referal system for consultations with neurologists and headache specialists
– Internet forum and consultations
– National headache journal widely open for neurologists as well GPs
•
International cooperation
– Guidelines
– Meetings
– International headache journals subscrptions
•
Free market mechanisms for triptans
The POSSIBILITIES how to IMPROVE it!
• Maxalt (rizatriptan) - $ 13/ tab = Euro 9/ tab
• Zomig (zolmitriptan) - $ 12/ tab = Euro 8,7/ tab
• Relpax (eletriptan) - $ 7,5/ tab = Euro 5,2/ tab
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Imigran (sumatriptan) – $ 6,5/ tab = Euro 4,7/ tab
Sumamigren (sumatriptan) - $ 5,9/ tab = Euro 4,2/ tab
Sumigra (sumatriptan) – $ 5,2/ tab = Euro 3,9/ tab
Cinie (sumatriptan) - $ 3,3/ tab = Euro 2,4/ tab
............................... - $ 1,4/ tab = Euro 1/ tab
or reimbursements (realistically – no chance!)