Factbook of Pain. Dutch Volume. Chronic Pain

Transcription

1 Factbook of Pain Dutch Volume Chronic Pain

2 My presentation is about

3

4 From Supply to Demand From Institution to Patient centered 4

5 The Continuity of Care Domain

6 Health Reform Aim Balance responsibilities for all parties Hypothesis Competition will increase value for money Approach Combine sickness fund and private insurances Mix elements of traditional social insurance (i.e. public guarantees) with competitive elements (execution by private companies).

7 Health Markets Focus on Quality and Transparency Health Insurers Health Insurance Market Care Purchasersmarket Government Insured / Patients Care Provision market Care Providers 7

8 The Grunenthal Factbook of Pain

9 Objectives Retrospective health economic analysis Identification of Patiënt groups with Chronic Pain Farmaceutical innovations with greatest value Health Costs related to Chronic Pain Improvement of quality of life by changes in the health delivery Cost drivers

10 Hypotheses 1. Patients with Chronic Pain are Comorbid 2. Treatment for Chronic Pain Patients is expensive 3. Patients with Chronic Pain are under, over or mis treated 4. Optimal pain treatment saves lifes and costs

11 Dutch Project Structure Contract Contract

12 European Factbook approach

13 DISCLAIMER The Data have been available only for three weeks The Analysis is in stage One and preliminary The Casemagic tool has only been released last Friday So what we present is a first step to give an indication of the kind of data we have and the analysis we can do to develop the model

14 Data from Insurance Company (INC) Over 4 million insured Data Collected by VEKTIS IZIZ HospitalCare Database DISH Extramural Drugs & Devices database Basic Base package and Added Services

15 Dutch insurance Charge datasets used Extramural Drugs Hospital DBC costs Insured ID (Pseudonym) Ageclass Sex Postalcode Pharmaceuticals ID Farmacy Maingroup Costs DDD Year Quarter Month Hospital Treatment ID Specialty Costs DBC code / Diagnosis Start date End date 17

16 Factbook of Pain First Results Last weeks analysis

17 Pain related Drugs Classification The WHO three Step classification is used STEP 1 also for Cardiac problems STEP 2 STEP 3 Opiods Stap ATCODE omschrijving 1 B01AC06 ACETYLSALICYLZUUR N02BA01 ACETYLSALICYLZUUR N02BE01 PARACETAMOL 2 N02AA59 CODEINE, COMBINATIEPREPARATEN N02AC04 DEXTROPROPOXYFEEN N02AX02 TRAMADOL N02AX52 TRAMADOL, COMBINATIEPREPARATEN R05DA04 CODEINE 3 N01AH01 FENTANYL N01AH03 SUFENTANIL N02AA01 MORFINE N02AA03 HYDROMORFON N02AA04 NICOMORFINE N02AA05 OXYCODON N02AB02 PETHIDINE N02AB03 FENTANYL N02AD01 PENTAZOCINE N02AE01 BUPRENORFINE N04BC07 APOMORFINE Pijnbestrijders per stap, die ook gedeclareerd zijn in 2007.

18 Some definitions User Every client with an extramural Drug Reimbursement Charge Chronic User A user with more then 84 Defined Daily Doses reimbursement Charges in one Calender year 28 april

19 INC Insuredcomparedto other insurers The INC-population age distribution resembles those of other insurers INC is representative for the Dutch population. 28 april

20 Distribution Step 3 patients to the total INC Step 3 Patients start to grow after april

21 The percentage users of step 3 pain related drugs rises with age to a maximum of 15% for the 90+ers. 28 april

22 Analysis of the Step 1, 2 and 3 Patients 28 april

23 STEP 1, 2 and 3 : Users, Charges and DDD declaranten USERS Stap 3 9% Stap 1 31% Charges Extramural Drugs Kosten Stap 1 16% Stap 2 9% DDD DDD Stap 3 5% Stap 3 61% Stap 2 23% Stap 2 60% Stap 1 86%

24 The Chronic Dimension of Users, Costs and DDD For step 2 and 3 p p 120% % declaranten chronisch % kosten chronisch % DDD chronisch 100% 80% 76% 78% 60% 54% 54% 40% 20% 0% 5% 14% Stap 2 Stap 3 Chronic Users in Step 2 and 3 is limited : 5 resp 14% But the contribution of Chronic Users to costs and DDD is remarkable. 28 april

25 Population of the Insurance Company 4,3 million insured Step 3 users 1,4 % of total and 10 % of Costs Male Female Total april

26 Chronic / Users by step 3 Opiods Nr Users per insured Aantal gebruikers per verzekerden FENTANYL SUFENTANIL MORFINE HYDROMORFON NICOMORFINE OXYCODON PETHIDINE FENTANYL PENTAZOCINE BUPRENORFINE APOMORFINE niet chronisch chronisch Most used Opiods are : Morfine, Oxycodon and Fentanyl. The Chronic Users mostly use Fentanyl. 28 april

27 DDD step 3 Opiods Nr DDD per insured Aantal DDD per verzekerden FENTANYL SUFENTANIL MORFINE HYDROMORFON NICOMORFINE OXYCODON PETHIDINE FENTANYL PENTAZOCINE BUPRENORFINE APOMORFINE niet chronisch chronisch The Three most prescribed : Morfine, Oxycodon Fentanyl Mostly for chronic users 28 april

28 Step 3 users have in average 7 times higher costs then non users 28 april

29 Specialties involved in Step 3 patients

30 Charges Step 3 group vs Others

31 Hospital costs by Diagnosis

32 Base for next step Indication of the relation of Health Care costs for Patients treated with Step 3 Opiods Butwhatis driving the costs Casemagic Tool for further analysis

33 Case Magic Tool

34 2008 All and with admission

35 Step 3 < 3 Months

36 Conclusions so far Preliminary Answer Patiënt groups with Chronic Pain Health Costs related to Chronic Pain Still Open Farmaceutical innovations with greatest value Improvement of quality of life by changes in the health delivery Cost drivers

37 NEXT STEPS