Andrzej Śliwczyński

The implementation of an organised cervical screening programme in Poland: an analysis of the adherence to European guidelines

BackgroundWell-organised quality-controlled screening can substantially reduce the burden of cervical cancer (CC). European guidelines (EuG) for quality assurance in CC screening provide guidance on all aspects of an organised screening programme. Organised CC screening in Poland was introduced in 2007. The purpose of our study was to analyse: (i) adherence of the programme to EuG; (ii) programme process and performance indicators; (iii) impact of the programme on the incidence of and mortality from CC.MethodsAvailable data on the policy, structure and functioning of the Polish programme were compared with the major points of the EuG. Data on the process, and available performance indicators were drawn from the screening database and other National Health Fund (NHF) systems. Joinpoint regression was used to assess changes in CC incidence and mortality trends.ResultsThe Polish programme adheres partially to EuG in terms of policy and organisation. Only a limited set of performance indicators can be calculated due to screening database incompleteness or lack of linkage between existing databases. The screening database does not include opportunistic smears collected within NHF-reimbursed or private care. The organised programme coverage rate fluctuated from 21% to 27% between 2007-2013. In 2012 the coverage reached 35% after combining both organised and opportunistic smears reimbursed by the NHF. In 2012 the number of smears reimbursed by NHF was 60% higher in opportunistic than in organised screening with significant overlap. Data from the private sector are not recorded. Depending on years, 30-50% of women referred for colposcopy/biopsy because of abnormal Pap smears were managed within the programme. The age-standardised CC incidence and mortality dropped linearly between 1999 and 2011 without evidence of a period effect.ConclusionsThe Polish organised cervical screening programme is only partially adherent to evidence-based EuG. Its implementation has not influenced the burden of CC in the country so far. Changes with special focus on increasing coverage, development of information systems and assessment of quality are required to increase programme adherence to EuG and to measure its effectiveness. Our findings may be useful to improve the Polish programme and those implemented or planned in other countries.

Cervical Cancer Histology, Staging and Survival before and after Implementation of Organised Cervical Screening Programme in Poland

A population-based organised cervical cancer screening programme (OCCSP) was introduced in Poland in 2006. In this study we have aimed to analyse whether selected parameters related to invasive cervical cancer (ICC) of patients diagnosed in two distant gynaecological oncology centres changed after the first screening round of the programme run between 2006–2008. We have run a retrospective cross-sectional analysis of 189 women diagnosed with ICC between 2002–2005 (directly before introduction of the programme) and 165 patients diagnosed between 2009–2012 (just after the first screening round of the programme) and compared their age at diagnosis, histology, stage of tumours and overall survival (OS). Mean age of patients diagnosed in years 2002–2005 and 2009–2012 was 52.1 and 52.6 years respectively. Squamous cell carcinomas constituted 90.5% and 86.1% of tumours diagnosed in years 2002–2005 and 2009–2012 respectively and the rest of tumours had glandular and other histologies. 74.5% and 61.0% of women diagnosed in years 2002–2005 and 2009–2012 respectively had early ICC (FIGO—International Federation of Gynaecology and Obstetrics stages I-IIA) and the rest had advanced disease (FIGO IIB-IV). We have noticed no significant differences in mean age of patients, histology of tumours and OS of patients with ICC diagnosed before and after the first screening round of OCSSP in Poland. Advanced stages of ICC were more commonly diagnosed after the introduction of OCSSP. Changes only in some clinical parameters of patients with ICC were noticed before and after the first screening round of OCSSP in Poland but OS of patients remained the same.

Prevalence of psoriatic arthritis and costs generated by treatment of psoriatic arthritis patients in the public health system – the case of Poland

Objective The objective of the study was to analyse the prevalence of psoriatic arthritis (PsA) in Poland and to assess the costs generated by treatment of PsA patients in the system of public healthcare. Material and methods The analysis was based on the database of the public payer, the National Health Fund (NFZ). PsA was defined by the diagnostic ICD-10 codes M07 (Enteropathic arthropathies) and L40.5 (Psoriatic arthropathies). The estimate of the costs was based on the reports submitted to the NFZ by health service providers. The prevalence rates were calculated using the NFZ data and the population estimates from the Central Statistical Office of Poland (GUS). Results In 2015, the prevalence of PsA (ICD-10: L40.5 and M07) in Poland was 3.2 per 10 000 population (3.7 in women and 2.6 in men). In 2015, nearly 7.3 thousand patients with the diagnosis of M07 and 6.3 thousand patients with the diagnosis of L40.5 received healthcare benefits. Women accounted for 60.6% of those patients. Nearly three fourths of PsA patients were aged 40 to 69 years with the median age of 54 years (56 years in women and 50 years in men). Between 2008 and 2015 the NFZ expenditure on the treatment of PsA increased from 6.6 million Polish zloty (PLN) (1.9 million EUR) to PLN 50.8 million (12.1 million EUR). In the same period, the number of PsA patients increased from 3.4 thousand to 11.9 thousand. In 2015, the mean cost of treatment per PsA patient was PLN 3.8 thousand. Conclusions The PsA prevalence rates estimated by the authors from the NFZ database are clearly lower than those derived from studies in other European countries, which may suggest that the actual number of PsA patients in Poland may be underestimated. Still the number of patients treated for PsA increased nearly 3.5-fold during 2008–2015, when the cost of PsA treatment rose more than 7 times.

Reimbursed Costs of Management of Uterine Cervical Lesions in Poland--a Descriptive Analysis of Data from the National Health Fund and the Ministry of Health.

BACKGROUND Despite implementation of organised screening programme in 2006/2007, cervical cancer (CC) incidence and mortality in Poland are still higher than the average in the European Union. CC and preceding cervical intraepithelial neoplasia (CIN) caused by human papillomaviruses (HPVs) can be prevented by vaccines which are reimbursed in around 20 European countries but not in Poland. CC and CIN can be also detected with the use of HPV tests which are not included in the Polish screening programme. Reimbursement for HPV vaccines and HPV testing requires cost-effectiveness analyses which include country-specific data on the burden and costs of management of cervical neoplasia. Therefore, we investigated the burden of cervical neoplasia and direct costs associated with its detection and management in Poland in 2012 reimbursed by the National Health Fund (NHF) - the only public healthcare insurance institution. We also report administrative costs of the organised screening programme covered by the Ministry of Health. METHODS Data on the burden and reimbursed costs of organised and opportunistic screening as well as management of cervical neoplasia were drawn from the NHF databases. Numbers of women reported with CIN and CC were ascertained. RESULTS In 2012, there were 765,266 and 1,288,358 reimbursed Pap smears collected within and outside the organised screening programme, respectively. Expenditures on medical and administrative procedures in organised screening reached PLN (Polish Zloty) 41,470,664 and 12,150,398 respectively. The number of women with particular diagnosis and reimbursement for the management of these lesions were as follows: glandular ectropion 208,033 and PLN 37,349,515; CIN1 10,521 and PLN 6,616,375; CIN2 5,812 and PLN 5,071,155; CIN3 6,487 and PLN 7,611,062; unspecified grade CIN 36,575 and PLN 12,352,034; and CC 33,482 and PLN 52,377,006, respectively. In women with ectropion and CIN the total number of local excision/ablative therapeutic procedures on the cervix reached 47,658 and the total number of hysterectomies was 1,321. CONCLUSION In 2012, management of approximately 93 thousand women with HPV-related cervical lesions reimbursed in Poland amounted to PLN 84,027,632 which makes it a considerable public health problem. The number of women managed for glandular ectropion is considerable and related costs are high. Total reimbursement for detection, treatment and follow-up of all cervical lesions reaches at least PLN 137 million annually.

Drug-class-specific changes in the volume and cost of antidiabetic medications in Poland between 2012 and 2015

Aim to investigate the drug-class-specific changes in the volume and cost of antidiabetic medications in Poland in 2012–2015. Methods This retrospective analysis was conducted based on the National Health Fund database covering an entire Polish population. The volume of antidiabetic medications is reported according to ATC/DDD methodology, costs—in current international dollars, based on purchasing power parity. Results During a 4-year observational period the number of patients, consumption of antidiabetic drugs and costs increased by 17%, 21% and 20%, respectively. Biguanides are the basic diabetes medication with a 39% market share. The insulin market is still dominated by human insulins, new antidiabetics (incretins, thiazolidinediones) are practically absent. Insulins had the largest share in diabetes medications expenditures (67% in 2015). The increase in antidiabetic medications costs over the analysed period of time was mainly caused by the increased use of insulin analogues. Conclusions The observed tendencies correspond to the evidence-based HTA recommendations. The reimbursement status, the ratio of cost to clinical outcomes and data on the long-term safety have a deciding impact on how a drug is used.

Regional differences in the frequency of diabetes occurrence and its treatment costs during the years 2008–2013, based on the NFZ (National Health Fund) database

In the European region in 2013 the International Diabetes Federation (IDF) estimated the number of patients with diabetes at 56 million [1]. The costs of treatment in Europe were estimated at 140 million Euro. Recently Tamayo et al., when presenting the data for Poland in the updated IDF Diabetes Atlas report, estimated the morbidity at approx. 6.5% [2]. This number was estimated based on the “Wieloośrodkowe Ogolnopolskie Badanie Stanu Zdrowia (WOBASZ)” project of 2003–2005 and earlier analyses from 1998–2001 [3]. Other studies include: Screen-Pol, Polish Multicenter Study on Diabetes Epidemiology (PMSDE) and “Nadciśnienie Tetnicze w Polsce Plus Zaburzenia Lipidowe i Cukrzyca (NATPOL-PLUS)” [4–6]. These analyses were partially local or were based on relatively small groups of patients. In 2004 the total cost of diabetes treatment in Poland was estimated at approx. PLN 6 billion [7]. High social costs of diabetes necessitate uninterrupted preventive activities, enabling the restriction of morbidity and public expenses for its treatment. The studies dedicated to regional variability of diabetes prevalence may help to identify specific risk factors and differences in management. In the region of Europe the differences of morbidity are very high, within the range from 2.4% in Moldavia up to 14.9% in Turkey [2]. In addition to the actual differences in the frequency of occurrence, they certainly are related to uneven and not fully reliable method of data calculation in individual countries [2]. Within Poland, the regional data concerning the frequency of diabetes occurrence in the years 2003–2005 ranged from 4.2% in women in Malopolska province up to 9.0% in men in Wielkopolska province [3]. Current data on regional differences may form the basis for future more detailed analyses on social, epidemiological and economic reasons for the variability of diabetes occurrence frequency in Poland.

Prevalence of diabetes in Poland in the years 2010–2014

Introduction. Each year diabetes affects larger and larger number of people. Despite this fact, the number of people suffering from diabetes in Poland is not known precisely. In order to assess this prevalence, the thesis aims at assessing the prevalence of diabetes in the years 2010–2014 in the total Polish population by using the databases of the National Health Fund. Material and methods. In the period from 1st January 2010 until 31st December 2014 patients were distinguished according to PESEL (Personal Identification) numbers: 1. for whom health care providers have indicated diabetes-related ICD-10 codes as the main cause of the medical intervention in billing reports; 2. who had got their prescriptions filled for any hypoglycemic agents or for glucose meter test strips. The number of patients recorded as diabetes patients according to the ICD-10 code and the number of patients who had their prescriptions filled for hypoglycemic agents or test strips were assessed. On the basis of these data the prevalence of diabetes (percentage of people with diabetes in a given year or a percentage of people who had got their prescriptions filled for hypoglycemic agents or test strips in relation to the general population) in respective years and an average prevalence rate for respective voivodeships were assessed. Results. The average percentage of people with diabetes in the years 2010–2014 were found to be 4.47% (± 0.09%). This percentage has gradually increased in the consecutive years from 4.39% in 2010 to 4.61% in 2014. The average percentage of people who had got their prescriptions filled for diabetes related medicines or glucose meter test strips amounted to 5.88% in the years 2010–2014. The largest percentage of people with diabetes was in Silesian Voivodeship and amounted to 5.5% (± 0.1%), the second consecutive voivodeship was Łódź with 5.0% (± 0.2%) of people with diabetes and Opole Voivodeship on the third place with 4.9% (0.1%) inhabitants with diabetes. The smallest percentage of people with diabetes was noted in Warmian-Masurian Voivodeship — 3.5% (± 0.1%) and Subcarpathian Voivodeship — 3.6% (± 0.2%). Conclusions. 1. Average diabetes prevalence rate in Poland in the years 2010–2014 amounted to 4.47% (the assessment was carried out on the basis of the number of people recorded by the National Health Fund as patients with diabetes) or 5.88% (assessment on the basis of the number of people who got their prescriptions filled for reimbursable hypoglycemic agents or glucose meter test strips). 2. Diabetes prevalence in Poland increases in the consecutive years. 3. Prevalence of diabetes varies among voivodeships. (Clin Diabet 2015; 4, 6: 232–237)

Epidemiology of Rheumatoid Arthritis (RA) in rural and urban areas of Poland – 2008–2012

OBJECTIVE The aim of this study is to investigate the morbidity rate due to Rheumatoid Arthritis (RA) in the Polish population during 2008-2012, calculated per 1,000 inhabitants, and taking into account the differences between provincess, area of residence (urban or rural) and gender. MATERIALS AND METHOD From the NFZ IT systems, PESEL number information was obtained for all 17 types of services contracted in 2008-2012, for patients whose main diagnosis in the report was the ICD-10 disease code: M05.X - seropositive rheumatoid arthritis, or M06.X - other rheumatoid arthritis. The number of patients, gender and age were calculated based on the PESEL number provided in the statistical reports of the patient with the analysed ICD-10 diagnosis. Urban and rural cases were compared using commune zip codes. The basis for classifying the patient as a member of an urban or rural population was the Zip Code of the declared place of residence. Urban and rural areas are classified based on administrative criteria provided by the Central Statistical Office: the National Official Register of Territorial Division of the Country (TERYT). RESULTS During the studied period the number of RA patients increased from 173,844-230,892. In urban areas, the most patients were recorded in the Śląskie Province, the least in Lubuskie Province. Patients from rural areas were approx. 1/3(rd) of the total population of patients in Poland. In rural areas, the most patients were recorded in the Mazowieckie Province, the least in Lubuskie Province. The morbidity rate in cities was 5.08 in 2008 and increased to 8.14 in 2012 in rural areas, respectively, it was 3.74 and increased to 3.98. Regardless of the place of residence the women fell ill 3.5 times more frequently. The lowest morbidity rate, both in rural and urban areas, was recorded in the Lubuskie Province, the largest in Świętokrzyskie Province. The the most probable explanation of the highest morbidity rate in the latter province is a worse access to a rheumatologist: in this province there is the lowest number of inhabitants per one employed rheumatologist. CONCLUSION In Poland, the number of RA sufferers is increasing, which is probably a result of increasing life expectancy. In Poland, also exists a differences in morbidity between urban and rural inhabitants. Differences may also derive from undiagnosed cases of the disease.

Glove failure in elective thyroid surgery: A prospective randomized study

OBJECTIVES To analyze perforation rate in sterile gloves used by surgeons in the operating theatre of the Department of Endocrinological and General Surgery of Medical University of Lodz. MATERIAL AND METHODS Randomized and controlled trial. This study analyses the incidents of tears in sterile surgical gloves used by surgeons during operations on 3 types of thyroid diseases according to the 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes. Nine hundred seventy-two pairs (sets) of gloves were collected from 321 surgical procedures. All gloves were tested immediately following surgery using the water leak test (EN455-1) to detect leakage. RESULTS Glove perforation was detected in 89 of 972 glove sets (9.2%). Statistically relevant more often glove tears occurred in operator than the 1st assistant (p < 0.001). The sites of perforation were localized mostly on the middle finger of the non-dominant hand (22.5%), and the non-dominant ring finger (17.9%). CONCLUSIONS This study has proved that the role performed by the surgeon during the procedure (operator, 1st assistant) has significant influence on the risk of glove perforations. Nearly 90% of glove perforations are unnoticed during surgery.

Effectiveness and costs of breast cancer therapy in Poland: a regional approach

Wstep . Rak odbytnicy jest w Polsce jednym z najczestszych nowotworow, z rosnącą zachorowalnością. Porownania miedzynarodowe wskazują na zaleznośc pomiedzy wydatkami na ochrone zdrowia a wskaźnikami 5-letniego przezycia chorych na nowotwory. W niniejszej pracy, po raz pierwszy w Polsce, przedstawiono analize związku pomiedzy wskaźnikami 5-letniego przezycia wśrod chorych na raka odbytnicy w poszczegolnych wojewodztwach a ponoszonymi tam wydatkami na ich leczenie. Material i metody . W pracy wykorzystano dane NFZ dostepne w systemie pn. „Rejestr Leczenia Chorob”. Analizie poddano okolo 25 tysiecy chorych na raka odbytnicy, ktorzy rozpoczeli leczenie w latach 2005–2008. Wykonano analize porownawczą wskaźnikow 5-letniego przezycia wśrod tych osob oraz wydatkow ponoszonych w calym cyklu ich leczenia z podzialem na poszczegolne wojewodztwa. Wyniki . Wskaźniki 5-letniego przezycia chorych na raka odbytnicy w Polsce w latach 2005–2008 utrzymywaly sie na podobnym poziomie (okolo 41% u mezczyzn i okolo 45% u kobiet), przy wzglednie duzej roznicy w poszczegolnych latach na poziomie wojewodztw (w granicach od 36% do 45% u mezczyzn i od 39% do 49% u kobiet). Stwierdzono takze znaczne roznice pomiedzy wojewodztwami w wysokości wydatkow na leczenie; wśrod mezczyzn wynosily one za caly cykl leczenia od 32,3 do 41,0 tys. PLN na osobe, a u kobiet od 27,0 do 33,3 tys. W wiekszości porownan nie wykazano związku pomiedzy średnią wysokością wydatkow na leczenie a wskaźnikami 5-letnich przezyc. Wnioski. Przedstawiona analiza wskazuje na brak zalezności pomiedzy średnimi wydatkami i wynikami leczenia chorych na raka odbytnicy w Polsce. Przyczyny roznic w wynikach leczenia mogą byc zatem zalezne od innych czynnikow, np. stadium klinicznego nowotworu w chwili rozpoczecia leczenia lub odmiennych sposobow leczenia. Poglebienie tej analizy z uwzglednieniem przyczyn moze sie przyczynic do zmniejszenia regionalnych roznic w opiece zdrowotnej i nierowności w uzyskanych wynikach leczenia raka odbytnicy w Polsce.