EU Osteoporosis Report SWEDEN

Transcription

1 EU Osteoporosis Report SWEDEN Completed by: Kristina Åkesson, Bone & Joint Decade Eva Waern, Andreas Kindmark, Caroline Åkerhielm Swedish Rheumatism Association OVERVIEW Ref: Osteoporosis in the European Community: A Call to Action, Nov 2001 IOF publication Ref: Osteoporosis in Europe: Indicators of Progress, Feb 2005, IOF publication Ref: Osteoporosis in Europe: Indicators of Progress, Feb 2005, IOF publication National population 8,900, Data from the Statistics Sweden Population over 50 3,200, Women: (50.5%) Men: Data from the Statistics Sweden Number of hip fractures in , per 10,000 population Number of hip fractures in 1999 n/a Number of hip fractures in per 10,000 population Number of hip fractures in (2005) 20.6 per 10,000 population Data for ICD S72. Data for 2006 not yet available. Data from the National Board on Health and Welfare (NBHW) Database Individual hospital cost of hip fracture: Estimated

2 direct costs indirect costs Average number of hospital days in acute care Cost/day (Euro) Direct: 10,000 Indirect: not recorded Direct: 10,000 Indirect: not recorded Women: 9.4 Men: 9.7 Total: 9.5 Data from the NBHW Database Cost/day n/a Average number of days in rehabilitation or long term care Cost/day (Euro) Total direct hospital costs of hip fractures 300,000,000 (1998) No new estimation available Number of diagnostic scanners (DXA) per million population Recommended: In total 85 total body scanners. 9 per million or 26 per million over age 50. The geographic distribution is however unequal with 60% around Stockholm and only 5% in northern Sweden. Waiting time for DXA scan in the public health system 1-6 months 2 weeks -6 months Private scanners are now available. Cost for DXA scan of hip and spine for hip and spine combined based on list price in the public sector. The price will vary depending on what is included and where the scanner is located. How many DXA scans are carried unrecorded out/year? DXA reimbursement (public system) Yes, no restrictions Yes, no restrictions criteria for reimbursement Reimbursement of proven therapies Yes, no restrictions Yes, but restrictions apply to new expensive treatments i.e. PTH but also to therapies not regarded as fully efficacious (ibandronte). The drug is available for full payment by the patient. 2

3 2001 Audit* 2007 Report 8 RECOMMENDATIONS *Osteoporosis in the European Community: A Call to Action. IOF publication - November IS OSTEOPOROSIS A PRIORITY? 1:a Has your government made osteoporosis a national health priority? 1:b Has your government supported national or regional osteoporosis campaigns? 1:c Do national initiatives advance or restrict the cause? No, but projects have been supported by Swedish Council on Technology Assessment in Health Care (SCTAMC) NBHW (National Board of Health and Welfare) published state-of-the-art reports on osteoporosis, hip fracture treatment & guidelines to MDs Unrecorded No. A recent initiative by the NBHW is recently initiated to evaluate and possibly address priority for musculoskeletal conditions including osteoporosis. No campaigns directed at the public. Information assembled and distributed by national agencies as before. NBHW (National Board of Health and Welfare) published state-of-the-art reports on osteoporosis, hip fracture treatment & guidelines to MDs A national initiative the expert panel on osteoporosis has been active with leading the experts in osteoporosis since The group has arranged an annual meeting, inviting all stakeholders at a conference centre in Stockholm. The meeting is usually attended by persons. 3

4 2. FRAGILITY FRACTURE STATISTICS 2:a Has a national fragility fracture registry been established for data collection and monitoring? 2:b If so, give dates for data 2:c Is collected data from general or selected populations? 2:d Incidence rates for hip fracture for men & women over 50 years (per 10,000 population) 2:e Prevalence rates for vertebral fracture for men & women over 50 years (per 10,000 population) 2:f Incidence and/or prevalence of wrist and other non-vertebral fracture for men & women over 50 years No There is no register for fragility fractures all over. However, there is a specific register for hip fractures and their treatment. In addition, there is a specific register for all those fracture patients treated with total or semi-total hip replacement. Data for the register are from the general population and not selected populations. It is possible to retrieve data from the NBHW database, which rely on data from hospital ICD coding for in-patient care of hip fracture patients and types of surgical procedures. This type of data is not reliable for detailed analysis of incidence, without through data control. 4

5 3. CO-OPERATION AND FUNDING 3:a Which partners have been supportive of your osteoporosis efforts? (corporate, allied health, government) Give specifics 3:b Did these partners collaborate on mutual goals & objectives? None known or recorded The expert panel has been supported by corporate partners. In addition, corporate partners are members of the Swedish Osteoporosis Society and the Patient Osteoporosis Society. The governmental agencies; NBHW, Medical Product Agency and Swedish Technology Assessment Agency (SBU) have continuously evaluated the evidence base for diagnostic tools and treatment using expert panel. Restrictions apply since 3 years as to what extent industry can be involved in professional education. Hospitals have accepted indirect funding for development of Fracture Liaison Services. 4. CALCIUM AND VITAMIN D 4:a Is there a national public health program? 4:b Are there national guidelines on optimum daily intake? Nothing national, however local & regional programs Unrecorded The National Food Administration has recommendations for calcium and vitamin D. In addition, SCTAHC has made and audit regarding these studies on vitamin D and calcium. Yes, see above. 5. ACCESS TO BONE DENSITOMETRY SYSTEMS 5:a Number of hip & spine DXA units (per million population) 4.8 In total 85 total body scanners. 9 per million or 26 per million over age 50. 5

6 5:b Is the distribution of services equitable throughout your country? 5:c Cost of DXA (public and private health systems) Unknown The geographic distribution is however unequal with 60% around Stockholm and only 5% in northern Sweden. 20% in the western part and 15% in the southern for hip and spine combined based on list price in the public sector. The price will vary depending on what is included and where the scanner is located. 5:d Utilization of scans: Public Private 5:e Are diagnostic procedures (DXA) reimbursed? If yes, what are the criteria for reimbursement? 5:f Average wait time for DXA (public and private systems) 5:g Quality Assurance: is there standardized training of technologists? Not known Mostly public system, with partial fee payment Public: 2 weeks 3 months Private: unknown Unrecorded Not known. Reimbursed in the public health care system and as for all other medical care and with partial fee for the patient. Public: 2 weeks 6 months Private: unknown Training programs have been sponsored by the manufacturers. A course has been given about every other year by persons with qualifications from Int Clin Densitometry Soc. 6

7 6. PREVENTION, TREATMENT AND REIMBURSEMENT 6:a Do evidence based guidelines exist on prevention, diagnosis and treatment? (if yes, give date & link to publication) 6:b What approved drug therapies are available? Yes, MPA (Medical Product Agency), Swedish Osteoporosis Society,SCTAHC Not recorded Yes, the Medical Product Agency updates its recommendations through an expert panel with the latest revision being published in SCTAHC revised review Bisphosphonates (alendronate, risedronate, zoledronic acid, etidronate), SERM (raloxifen), PTH (Teriparatide, PTH 1-84), strontium ranelate. 6:c Are the most effective treatments reimbursed? Please include criteria for reimbursement 6:d Are patients at high risk for fractures eligible for treatment reimbursement BEFORE the first fracture? Reimbursed with patient fee per annum. National drug insurance covers prescribed drugs. Public system - no restrictions Not recorded The National Drug Insurance covers prescribed drugs The maximum patient fee per annum is 200 Euro, drug costs above this amount are fully reimbursed. Criteria for reimbursement are defined by a national reimbursement committee limitations are based on evidence of efficacy for each specific drug. For example; the indication (reimbursement) for PTH is restricted to post-menopausal women with sever osteoporosis and multiple vertebral fractures or sever osteoporosis with new fractures while on other therapies, and strontium ranelate restricted to women above age 74. The reimbursement criteria are regularly revised. Restrictions are rarely considered to limit access to treatment in post-menopausal women. Yes. Women with a T-score below -2.5 are eligible for treatment or with if considered at high risk based on a combination of clinical risk factors, including age and steroid treatment. 7

8 6:e Do lifestyle prevention programs exist? Not recorded Yes 7. THE NGO SECTOR AND TRAINING HEALTHCARE PROFESSIONALS 7:a Has the government supported (financially or through public information) patient and scientific societies? 7:b Do appropriate training programs exist for health professionals? NBHW has denied Swedish Osteoporosis Society funding due to belief that OP not major health problem Included in all medical school curriculum, and other privately funded educational programs NBHW has denied Swedish Osteoporosis Society funding due to belief that OP is not major health problem Osteoporosis is included in all medical school curriculums. Other, sponsored, privately or publicly funded educational programs exists. Osteoporosis is included in specialty training programs for musculoskeletal conditions, regional and local educational programs for nurses and allied health professionals. 8. RESEARCH 8:a How many funding agencies are there in your country that fund bone research? Include details if available 8:b Specify major osteoporosis or related research 8:c Include references/links to publications Not recorded Numerous projects ongoing: male osteoporosis, physical activity in childhood The Swedish Medical Research Council awards competitive grants to bone research. Regional funds for research are also supporting bone research. Local foundations are supporting bone research. Numerous international, national and local research programs are ongoing on osteoporosis in both women and men evaluating environmental factors, lifestyle and genetic components of osteoporosis. 1) Socialstyrelsens riktlinjer för vård och behandling av 8

9 höftfraktur (National guidelines for management of hip fractures) HBWH 2003 ISBN: ) Page 2605.aspx Treatment recommendations from the MPA