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The multiple sclerosis patient’s journey in Poland was described based on the data collected by the Therapeutic Programme Monitoring System (System Monitorowania Programów Terapeutycznych, SMPT) between 2014 and 2018 and a National Health Fund (Narodowy Fundusz Zdrowia, NFZ) report entitled “NFZ on Health. Multiple Sclerosis.” It was found that about 90% of patients had their first multiple sclerosis diagnosis code (ICD-10: G35) assigned by a neurologist, usually during hospital stay in the department of neurology. Further patient management was usually continued in a neurology clinic. The waiting time for further outpatient and inpatient specialist (neurology) care after the first G35 diagnosis is more than 100 days. Before G35 diagnosis, patients most often presented with their first symptoms to neurological and ophthalmic clinics and were probably referred from these clinics for a magnetic resonance imaging. The analysis of the data from the Therapeutic Programme Monitoring System showed that the median time from the onset of the first symptoms to the diagnosis of multiple sclerosis was 7.4 months, and the median time from the diagnosis to initiation of first-line disease modifying treatment was 14.82 months. The length of time from the diagnosis to disease modifying therapy had a significant impact on the degree of disability. Patients treated with highly active second-line therapies accounted for 8.5% of all patients treated in drug programmes, and the increase in the number of patients on second-line regimens and expenditure on this programme were disproportionately lower compared to the first-line programme. A programme to improve the diagnosis and the quality of care for patients with multiple sclerosis should be developed in Poland to achieve better treatment outcomes. It is crucial to reduce the waiting time for diagnosis and the time interval between diagnosis and the onset of disease modifying treatment.

In a landmark multi-center, phase III, randomized controlled trial — PARADIGM-HF, that investigated long-term effects and safety of novel class of agents — angiotensin receptor antagonist/neprilisin inhibitor (ARNI) — LCZ696 (sacubitril/ /valsartan) in comparison with enalapril, clear clinical benefit was shown in patients with heart failure with reduced ejection fraction (HFrEF) who were subjected to sacubitril/valsartan. Sacubitril/valsartan ( Entresto TM ) has been avai- lable in Poland for the last two years. The present document is a practical guide for all those physicians who would like to initiate this new therapy for the first time and also for those have gathered so far some experience with Entresto TM .

Migraine is a common primary headache disease, which reduces quality of life. About 8% of migraineurs suffer from chronic migraine (CM), which is the most severe and troublesome type. It has been proven that onabotulinumtoxinA (ONA-BoNT/A) significantly improves CM, presumably inhibiting the release of calcitonin gene-related peptide (CGRP) and other neurotransmitters from c-fibres endings, and thus decreasing activation of nociceptive pathways and transmission of pain. The aim of this position paper was to assess the place of ONA-BoNT/A for the prophylaxis of CM in adults. The authors have compared the efficacy, safety and tolerance of the toxin to those of classical oral preventive therapies as well as to recently introduced anti-CGRP-pathway monoclonal antibodies. The results of randomised controlled studies of ONA-BoNT/A have been compared to open label (real world practice) trials.

Chronic lymphocytic leukemia (CLL) is a cancer that is epidemiologically difficult to describe arising from the definition of the blood cancers adopted in the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems. In Poland CLL cases accounted for 1.3% and 1% in men and 1 women respectively in 2013 (1.2% and 0.9% of deaths). The incidence for men was 3.3/100,000 and 1.7/100,000 in women (mortality rates being 1.8/100,000 and 0.7/100,000 respectively). In Poland, the median patient’s age is 69 years. Indicators of 5-year relative survival for patients diagnosed in 2006–2009 were 55.8% for men and 68.1% for women.

Starzenie sie spoleczenstwa i wzrastająca zapadalnośc na nowotwory hematologiczne jest wyzwaniem dla systemu ochrony zdrowia. Nowotwory hematologiczne stanowily okolo 5% wszystkich zachorowan na nowotwory ogolem w 2012 roku, a polowa chorych miala ponad 65 lat. Nowe standardy leczenia oraz technologie medyczne stwarzają szanse dla chorych, ale ich zastosowanie wymaga wnikliwych badan oraz potwierdzenia uzyteczności w ramach praktyki klinicznej. Warunkami adekwatnego dostepu pacjentow w Polsce do technologii medycznych w ramach aktualnych standardow terapeutycznych są optymalizacja i adekwatne finansowanie systemu opieki zdrowotnej. Wydaje sie, ze hematologia onkologiczna moze byc modelowym przykladem efektywnych rozwiązan systemowych — z pacjentem jako podmiotem tego systemu.

The article presents the public funding of health care in allergic diseases in terms of hospital treatment in 2014. On the basis of the National Health Fund (NHF) data available in the public domain, the authors analysed the financial outlay on the contracts by province and compared them with the waiting time for benefits. As a result, the analysis found inadequate public funding for hospital care to meet the growing health needs of the population in the field of allergic diseases. There have also been inter-province differences in the levels of financing hospital care and waiting lists.

The article presents the public funding of health care for allergic diseases in terms of outpatient specialist care in 2014. On the basis of the NHF data available in the public domain authors analysed the financial outlay on the contracts by province, and compared them with the waiting time for benefits and the number of allergists. As a result, the analysis found inadequate public funding to meet the growing health needs of the population in the field of allergic diseases. There have also been inter-province differences in the levels of financing health services and in the number of allergy specialists.

Heart failure has becoming an increasing medical, economic, and social problem globally. The prevalence of this syndrome is rising, and despite unequivocal positive effects of modern therapy, reduction of mortality has been achieved at the cost of more frequent hospitalisations. Unlike in many European countries, in Poland heart failure is usually recognised later, at a more advanced stage of the disease, leaving less time for ambulatory treatment and resulting in a high number of hospitalisations. The current paper presents the most important data regarding morbidity and mortality due to heart failure in Poland. The experts in the field focus on the key source of high costs of therapy and highlight several critical organisational deficits present in the Polish health care system. This background information builds a basis for a concept of coordinated care for patients with heart failure. The paper discusses the fundamental elements of the system of coordinated care for patients with heart failure necessary to enhance the diagnosis, improve therapeutic effects, and reduce medical, economic, and social costs.

Chronic obstructive pulmonary disease (COPD) is currently the third most common cause of death worldwide and the total number of people affected reaches over 200 million. It is estimated that approximately 50 % of persons having COPD are not aware of it. In the EU, it is estimated that the total annual costs of COPD exceed €140 billion, and the expected increase in the number of cases and deaths due to COPD would further enhance economic and social costs of the disease. In this article we present the results of cost analysis of health care benefits associated with the treatment of COPD and with the disease-related incapacity for work. The analysis is based on the data of the National Health Fund and the Social Insurance Institutions, public payers of health benefits in Poland. The annual 2012 expenditures incurred for COPD treatment was €40 million, and the benefits associated with incapacity for work reached more than €55 million. The extent of these expenditures indicates that it is necessary to optimize the functioning system, including the allocation of resources for prevention, social awareness, and detection of COPD at early stages when treatment costs are relatively low.

Chronic obstructive pulmonary disease (COPD) is currently the third most common cause of death worldwide and the total number of people affected reaches over 200 million. It is estimated that approximately 50 % of persons having COPD are not aware of it. In the EU, it is estimated that the total annual costs of COPD exceed €140 billion, and the expected increase in the number of cases and deaths due to COPD would further enhance economic and social costs of the disease. In this article we present the results of cost analysis of health care benefits associated with the treatment of COPD and with the disease-related incapacity for work. The analysis is based on the data of the National Health Fund and the Social Insurance Institutions, public payers of health benefits in Poland. The annual 2012 expenditures incurred for COPD treatment was €40 million, and the benefits associated with incapacity for work reached more than €55 million. The extent of these expenditures indicates that it is necessary to optimize the functioning system, including the allocation of resources for prevention, social awareness, and detection of COPD at early stages when treatment costs are relatively low.