EU Osteoporosis Report 2007-2008 MALTA Overview completed by: Dr Raymond Galea MD, FRCOG, Acc O&G.(Leu) Progress report completed by: Dr Raymond Galea in conjunction with the Strategy and Sustainability Division, Ministry for Social Policy and the Clinical Performance Management Unit, SLH/MDH. OVERVIEW 2007 National population 404,346 Population over 50 Women: (50+) = 70,228, (65+) = 30544 Men (50+) = 61,069, (65+) = 22172 Total (50+) = 131,297 Number of hip fractures in 1998 = or >65 years = 255 Number of hip fractures in 1999 = or >65 years = 238 Number of hip fractures in 2000 = or >65 years = 236 Number of hip fractures in 2006 = or >65 years = 321 7.9 per 10,000 population Individual hospital cost of hip fracture: direct costs indirect costs Average number of hospital days in acute care cost/day (euro) Average number of days in rehabilitation or long term care cost/day (euro) Total direct hospital costs of hip fractures 6 days in acute care @ 256.23 = 1537.38, major operation = 2329.37, prosthesis = 582.34 Total = 4449.09 6 days 256.23 per day 20 days 256.23 per day 9573.69 per hip fracture Total cost : 9573.69 per hip fracture x 321 fractures = 3,073,154 Number of diagnostic scanners (DXA) per million population Recommended: 10.6 Waiting time for DXA scan in the public health system Cost for DXA scan of hip and spine 20 2 public (1 per million population) 18 private (18 per million population) About 6 months The DXA scan is free in the public health sector
How many DXA scans are carried out/year? 8231 DXA reimbursement (public system) The DXA is free of charge criteria for reimbursement Please see section 5 below Reimbursement of proven therapies No 8 RECOMMENDATIONS 1. IS OSTEOPOROSIS A PRIORITY? 1:a Has your government made osteoporosis a national health priority? No 1:b Has your government supported national or regional osteoporosis campaigns? 1:c Do national initiatives advance or restrict the cause? Indirectly yes as part of an ongoing national campaign on healthy eating 2. FRAGILITY FRACTURE STATISTICS 2:a Has a national fragility fracture registry been established for data collection and monitoring? There is no fragility fracture registry as yet. 2:b If so, gives dates for data Not applicable 2
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) This data is collected from all patients in the health sector The data is for patients at or above the age of 65 years No data is available for vertebral fractures 2:f Incidence and/or prevalence of wrist and other nonvertebral fracture for men & women over 50 years No data is available for wrist or other non-vertebral fractures. 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? Government and pharmaceutical companies Yes 4. CALCIUM AND VITAMIN D 4:a Is there a national public health program? There is an ongoing national health campaign on healthy diet and the need for daily intake of calcium and vitamin D are part of this campaign. 4:b Are there national guidelines on optimum daily intake? Yes, LN 247/98 (transposition of Council Directive 90/496) sets the optimum daily intake of Vitamin D to µg 5 and that of Calcium to 800mg 3
5. ACCESS TO BONE DENSITOMETRY SYSTEMS 5:a Number of hip & spine DXA units (per million population) 20 (this is the number per million population. There are 10 units in Malta, two in the public sector and the rest in private sector.) Public: 1 per million population Private: 18 per million pop n. 5:b 5:c 5:d Is the distribution of services equitable throughout your country? Cost of DXA (public and private health systems) Utilization of scans: o Public o Private Yes the service is equitably distributed throughout the country The DXA in the public health sector is free of charge. In the private sector the price varies between 50 and 75 Euro. The latter is sometime reimbursed by private medical insurances. They are free in the public system - there is no restriction, all postmenopausal women are encouraged to have at least one scan. Other at risk categories are also encouraged to attend. 5:e Are diagnostic procedures (DXA) reimbursed? If yes, what are the criteria for reimbursement? See section 5.C 5:f Average wait time for DXA (public and private systems) The average waiting time in the public sector is about 6 months, within the private sector less then one week. 5:g Quality Assurance: is there standardized training of technologists? The average waiting time in the public sector is about 6 months, within the private sector less then one week. The technologists are trained in-house. 4
6. PREVENTION, TREATMENT AND REIMBURSEMENT 6:a Do evidence based guidelines exist on prevention, diagnosis and treatment?(if yes, give date & link to publication) Within the public health sector there are no definite evidence based guidelines on the prevention, diagnosis and treatment. 6:b What approved drug therapies are available? There are various approved drug therapies and these include, bisphosphonates, raloxifen, strontium ranilate and parathyroid hormone. 6:c Are the most effective treatments reimbursed? Include criteria for reimbursement No, there is no kind of reimbursement to patients for any kind of osteoporotic treatment except for cases of steroid induced osteoporosis. These patients are given IV Clodrinate in the hospital setup. 6:d Are patients at high risk for fractures eligible for treatment reimbursement BEFORE the first fracture? 6:e Do lifestyle prevention programs exist? There are no lifestyle prevention programs in place in the public sector. 7. THE NGO SECTOR AND TRAINING HEALTHCARE PROFESSIONALS Has the government supported (financially or 7:a through public information) patient and scientific societies? 7:b Do appropriate training programs exist for health professionals There is no financial support by government but there is some public information to the patient at a national level Health care professionals are being trained. 5
8. RESEARCH 8:a How many funding agencies are there in your country that fund bone research? Include details if available None 8:b Specify major osteoporosis or related research Research on Bone Density and Intervertebral disc space, Vitamin D status and Osteoporotic Fractures. 8:c Include references/links to publications 6