NFZ spent over PLN 1bn on therapeutic programmes in 2009

2010-09-01

The National Health Fund (NFZ) reported that in 2009 it spent over PLN 1bn (€249.7m) on therapeutic programmes, a measure of reimbursement for the most innovative and expensive health technologies for a selected number of patients. There were a total 35 therapeutic programmes in Poland in 2009, including eight oncological, 27 non-oncological, and three programme qualifications. In 2009 NFZ added nine new programmes, including the treatment of Pompe disease, mucopolysaccharydosis, cystic fibrosis, renal cancer and juvenile arthritis. The largest cost of treatment was generated by the breast cancer programme (PLN 200m or €49.9m), which consumed 18% of NFZ’s overall expenditure on therapeutic programmes in 2009; this was followed by hepatitis programme (PLN 156m or €38.9m), leukaemia programme (PLN 146m or €36.4m) and multiple sclerosis programme (PLN 110m or €27.5m). The drugs used in these programmes are also at the top of the list of drugs that yielded highest overall costs for NFZ in 2009. In contrast, the largest average cost of treatment per patient befell on mucopolysaccharydosis treatment with galsulfase, which amounted to PLN 945,717 (€236,125) whilst the average cost of breast cancer treatment per patient was only PLN 67,039 (€16,738). Roche and Novartis were the manufacturers which benefited the most from the sale of drugs in the therapeutic programmes in 2009.

For the last four years National Health Fund (NFZ) has been gradually increasing the value of expenditure and the number of the therapeutic programmes. In 2009 the NFZ’s budget allocated on therapeutic programmes was increased by 26% in comparison to the previous year and, according to, the amended 2010 budget NFZ is going to spend PLN 1.6bn (€411m) on therapeutic programmes, up by 50.5% to 2009. Unfortunately, the funds allocated for therapeutic programmes have been cut by 9.6% in the 2011 NFZ’s budget, to PLN 1.5bn (€371m). Nevertheless, healthcare experts concur that therapeutic programmes will become the preferred way of financing innovative and expensive treatment. There are several arguments to back this up. Firstly, all therapeutic programmes give the NFZ a unique opportunity to maintain control over expenditures on treatment and to prevent unreasonable drug use. Furthermore, most therapeutic programmes are described in a very detailed manner including restricted inclusion criteria the patients need to fulfil to be enrolled in the programme. In some programmes, the NFZ introduced an online register through which doctors are obliged to report the course of treatment. The weak side of the therapeutic programmes is the need of hospitalisation and the additional costs associated with that. Other obstacles include the limited number of providers and the complicated procedure which might well discourage both patients and doctors. Finally, some groups of patients find access to the treatment within therapeutic programmes to be unsatisfactory. The highly restrictive nature of eligibility criteria for the multiple sclerosis (MS) programme has meant that a monstrously low percentage of MS patients in Poland receive immunomodulating drugs; a mere 3%-5% of patients in Poland have access to such therapies – the lowest rate in Europe. The number of patients treated with interferon beta1 and beta2 in the therapeutic programme in H2 2009 was about 2,602 of the total 50,000-60,000 diagnosed. However, the programme provides treatment for three years only. The local MS patients’ organisation has, therefore, approached the Health Ministry in the hope of having some of the restrictions eased and access being extended to 15,000-16,000 patients who react positively to treatment or at least to those 5,000-6,000 patients who require immediate intervention. Anna Skoczylas-Ligocka Business Editor PMR Publications