Gestational diabetes mellitus/hyperglycaemia during pregnancy in Poland in the years 2010–2012 based on the data from the National Health Fund

Objectives: The incidence of gestational diabetes varies depending on a country and it is extremely difficult to analyse. The aim of the study was to assess the incidence of gestational diabetes in Polish population. Material and methods: Based on the data from the National Health Fund (NHF) the authors analysed reports regarding deliveries performed and then, determined the rates of gestational diabetes/hyperglycaemia during pregnancy and pregestational diabetes in Poland in the years 2010–2012. Results and conclusions: In Poland, the incidence of gestational diabetes was estimated to be 4.665% in 2010, 6.918% in 2011 and 7.489% in 2012. The incidence of pregestational diabetes was 1.067% in 2010, 1.116% in 2011 and 0.932% in 2012

Impact of alpha-adrenergic receptor antagonists use on outcomes in patients with heart failure. A post-hoc analysis using Polish National Health Fund database

Background: The alpha-adrenolytics (AA) are not recommended in patients with ejection fraction (EF) reduced heart failure due to safety concerns. The aim of our study was to assess the safety of AA in patients hospitalized due to exacerbation of HF and the influence of these drugs on long-term endpoints. Material and methods: Data collected by the National Health Fund tracking all patient admissions and taking of the drug prescriptions throughout the entire country was used. Patients hospitalized due to HF exacerbation were included. The primary outcome variable was all-cause mortality and the secondary was the first readmission due to HF or all-cause death occurring more than 30 days after discharge. Results: Of 140 668 patients hospitalized in the year 2013 53 317 were included and followed for a median of 56.3 months. AA patients had lower long-term all-cause mortality (52.8% vs. 54.9%, unadjusted p = 0.038). The treatment with AA positively and independently affected long-term survival [adjusted hazard ratio (adjHR): 0.82, 95% confidence interval (CI): 0.78–0.87, p < 0.001], as well as secondary endpoint (adjHR: 0.85, 95% CI: 0.81–0.90, p < 0.001). Cox analysis in the subgroup treated with beta-blockers revealed that treatment with AA was associated with lower mortality (adjHR: 0.82, 95% CI: 0.75–0.90, p < 0.001) and lower incidence of secondary endpoint (adjHR: 0.85, 95% CI: 0.78–0.92, p < 0.001). Conclusion: In compliant patients hospitalized due to HF exacerbation post discharge treatment with AA was safe and beneficial

Variation in treatment modalities, costs and outcomes of rectal cancer patients in Poland

Aim of the study: To evaluate outcome, costs and treatment differences in rectal cancer patients between various regions in Poland. Material and methods: Data from the Polish National Health Fund of all patients with rectal cancer diagnosed and treated between 2005 and 2007 were analyzed. Overall, relative 5-year survival and the percentage of patients receiving chemotherapy, radiotherapy and surgery were analyzed. The possible influence of cost of treatment per patient and mean number of rectal cancer patients per surgical oncologist were analyzed as well. Results: In total 15,281 patients with rectal cancer were diagnosed and treated in Poland in 2005–2007 within the services of the National Health Fund. The overall, relative 5-year survival rate was 51.6%. Curative surgery was performed in 64.1% of patients. Radiotherapy and chemotherapy were used in 47.5% and 60.7% of patients, respectively. The mean cost of treatment of one rectal cancer patient was 32,800 PLN and there were 49.8 rectal cancer patients per specialist in surgical oncology. Important differences between regions were found in all these factors, but without a significant influence on survival. A correlation between numbers of patients per specialist in different voivodeships and survival rates was observed, as well as a correlation between percentage of surgical resection in voivodeships and survival rates (p = 0.07). Conclusions: Results of treatment of colorectal cancer in Poland improved significantly during the last decade. There exist however, important disparities between regions in terms of method of treatment, costs and outcomes

Breast cancer treatment outcomes, therapy options and costs in Poland (2005–2007)

Wstęp. Na podstawie danych z „Rejestru Leczenia Chorych” NFZ przeprowadzono analizę wyników, metod i kosztów leczenia chorych na raka piersi. Chorzy i metody. W latach 2005–2007 leczono w Polsce po raz pierwszy z powodu raka piersi 43 738 chorych. Wyniki. W grupie tej zanotowano 79,8% względnych przeżyć 5-letnich (w poszczególnych województwach od 75,3% do 82,4%). Chemioterapia była stosowana u 69,4% wszystkich chorych (w poszczególnych województwach od 59,3% do 87,6%). Różnice pomiędzy województwami w zakresie leczenia napromienianiem były blisko dwukrotne (od 32,4% do 63%). Jednak jedynie różnice występujące pomiędzy województwami w częstości leczenia chirurgicznego (które mogą pośrednio świadczyć o różnicach w strukturze zaawansowania) oraz różnice w częstości wykonywania procedury „węzła wartowniczego” (które mogą świadczyć o różnicach w jakości leczenia) wiązały się znamiennie z różnicami w przeżyciach chorych. Zaobserwowano duże różnice w kosztach leczenia pomiędzy województwami (od 20 do 41 tys. zł), które nie korelowały z różnicami w przeżyciach chorych. Wnioski. W Polsce notuje się znaczącą poprawę wyników leczenia chorych na raka piersi. Duże różnice w wynikach, metodach i kosztach leczenia pomiędzy województwami mogą świadczyć o niestosowaniu jednolitych schematów postępowania oraz o niewłaściwym systemie refinansowania świadczeń.Introduction. The National Health Fund Patients’ Therapy Registry was analysed with special focus on the treatment outcomes, therapy options and costs. Patients and methods. 43,738 patients were diagnosed (for the first time) with breast cancer in Poland in 2005–2007. Outcomes. The overall relative 5-years survival was 79.8% (range 75.3%–82.4% in voivodeships). Chemotherapy was given to 69.4% of patients (range 59.3%–87.6% in voivodeships). Differences between voivodeships with reference to irradiation rate was almost double (range 32.4%–63.0%). Differences between voivodeships with reference to the ratio of surgically treated patients (reflecting differences in the disease stage at the diagnosis) and differences in the rate of sentinel node procedure (reflecting quality of surgery in the area) were significantly related to the treatment outcomes. There were significant differences in the treatment costs between voivodeships (from 20,000 to 41,000 PLN) which were not significantly related to the survival rate. Conclusions. There has been a significant improvement in treatment outcomes in Poland for breast cancer patients. Large differences in outcomes, therapy options and costs between voivodeships may reflect lack of adherence to therapy guidelines and suboptimal reimbursement of treatment costs

Porównanie liczebności zbiorów Krajowego Rejestru Nowotworów i Narodowego Funduszu Zdrowia na przykładzie nowotworów piersi u kobiet i nowotworów jelita grubego

Introduction. Two comprehensive and relatively complete systems collecting data on cancer co-exist inPoland: the National Cancer Register (NCR) registering incidence from the epidemiological viewpoint,and the system of the National Health Fund (NHF), which registers episodes of care for reimbursementpurposes. The aim of this study was to compare data from two systems, based on example of breastand colorectal cancers.Materials and methods. This study was based on the NCR and the NHF data from 2004–2010, coveringbreast cancer (C50) and colorectal cancer (C18–C21). The analysis was performed, comparing incidencedata (acc. to NCR), what is an epidemiological figure, and the number of new cancer patients treated inthe public insurance system (acc. to NHF), which is an organizational figure.Results. A 2007–2010 period is the most useful for comparison and the former one should be treatedwith care. In case of breast cancer, the number of new cases consequently rises, while the number ofpatients treated in the NHF remains at a constant level. In individual regions this picture is more diverse.In case of colorectal cancer, the number of cases registered by the NCR is a little higher than the numberof “confirmed” cases from NHF, though the trends in both registers are similar.Conclusions. It is an exceptional opportunity in Poland, to run two good quality cancer data sources. However,it is pertinent to note the definition and concept differences of data gathered in both systems, due towhich the systems are supplementing each other. Data quality in both systems improves gradually and itseems that data available after 2007 in both systems presents a quality allowing for sound conclusionsWstęp. W Polsce występuje unikalna sytuacja, gdy współistnieją dwa powszechne i stosunkowo szczelne systemy: Krajowy Rejestr Nowotworów rejestrujący zachorowania oraz system Narodowego Funduszu Zdrowia rejestrujący epizody leczenia osób z rozpoznaniem nowotworu. Celem pracy było porównanie liczby nowotworów zarejestrowanych w tych dwóch systemach na przykładzie raka piersi i raka jelita grubego. Materiał i metody. W pracy wykorzystano dane z KRN oraz z NFZ za lata 2004-2010, obejmujące chorych na raka piersi (C50) i na raka jelita grubego (C18-C21). Wykonano analizę porównawczą liczby zachorowań (KRN) (wartość epidemiologiczna) oraz liczby nowych pacjentów leczonych w systemie NFZ (wielkość o charakterze organizacyjnym). Wyniki. Porównanie danych historycznych wskazuje, że dane z ostatnich lat (2007-2010) można uznać za porównywalne, a poprzednie powinny być traktowane z dużą ostrożnością. W przypadku raka piersi obserwuje się, że liczba zachorowań zarejestrowanych w KRN w latach 2007-2010 stabilnie i dość szybko rośnie, podczas gdy liczba leczonych w ramach NFZ pozostaje na względnie stałym poziomie. Na poziomie poszczególnych województw sytuacja jest bardziej zróżnicowana. W przypadku raka jelita grubego liczba zachorowań rejestrowanych przez KRN jest nieco wyższa niż liczba „potwierdzonych” przypadków leczonych w ramach NFZ. Wnioski. Unikalne rozwiązanie występujące w Polsce, w którym w istnieją dwa, dobrej jakości źródła danych o zdarzeniach związanych z nowotworami, wymaga jednak dostrzeżenia różnic definicyjnych i koncepcyjnych leżących u podstaw budowy tych systemów. Systemy te nie dublują się, lecz uzupełniają. Jakość danych w obu źródłach stopniowo się poprawia i wydaje się, że w obu z nich dane dostępne po roku 2007 osiągnęły duży stopień zgodności

The incidence of major, nontraumatic lower amputations in patients without diabetes mellitus in Poland during 2009–2012, based on Polish National Health Found data

Duże amputacje kończyn dolnych wykonywane są głównie ze wskazań naczyniowych i jako powikłania zespołu stopy cukrzycowej. W niewielkim odsetku są konsekwencją urazu, nowotworów i wad wrodzonych. Autorzy na podstawie danych pochodzących z całej Polski, zawartych w rejestrach Narodowego Funduszu Zdrowia, obliczyli liczbę chorych, u których wykonano dużą nieurazową amputację kończyny dolnej oraz wskaźnik liczby dużych amputacji kończyn dolnych u chorych bez cukrzycy na 100 000 mieszkańców. Autorzy zaobserwowali istotne obniżenie się średniego wskaźnika z 11,23 ± 1,65 do 9,73 ± 1,22 (p < 0,05) na przestrzeni lat 2009–2012 w Polsce. Main of major amputations are related to the angiopathy of various origin and diabetic foot. The rest of amputations are consequence of injures, neoplasm’s and congenital malformation. An electronic search for entire was performed using Polish National Health Found database from 2009 until 2012 for incidence of non-traumatic major lower extremity was presented as a number of amputations per 100 000 individuals in populations. The authors presents that the mean rates of major amputations in people without diabetes mellitus diminished from 11.23 ± 1.65 to 9.73 ± 1.22 (p < 0.05) during 2009–2012 years in Poland.

Breast cancer treatment expenditures in Poland

Wstęp. Rak piersi jest jednym z najważniejszych problemów onkologicznych, a jednocześnie jest chorobą corazczęściej uleczalną. System zwalczania raka piersi powinien posiadać odpowiednią infrastrukturę oraz zapewniaćskuteczne klinicznie i uzasadnione ekonomicznie metody leczenia. W tej sytuacji istotna jest wiedza na temat wydatków(z punktu widzenia płatnika), a także kosztów (z punktu widzenia wykonawcy usług) leczenia, tak aby decyzjeo nakładach na leczenie raka piersi były obarczone najmniejszym możliwym ryzykiem. O ile w prowadzeniu leczeniazaleca się stosowanie metod opartych na dowodach o charakterze klinicznym (evidence based medicine), tak zarządzaniepowinno być oparte na dowodach o charakterze ekonomicznym (evidence based management). Niniejszaanaliza jest przyczynkiem do dyskusji na temat właściwego zarządzania fi nansami w leczeniu chorych na raka piersi.Materiał i metody. W pracy wykorzystano dane NFZ dostępne w systemie pod nazwą: Rejestr Leczenia Chorób. Analiziepoddano dane dotyczące około 104 tys. chorych leczonych w Polsce z powodu raka piersi w latach 2004–2010,to jest wszystkich chorych zidentyfi kowanych jako potwierdzone przypadki raka piersi fi nansowane w tym okresieprzez NFZ. Wykonano analizę wydatków na leczenie poszczególnych chorych, obejmującą wydatki ponoszone odrozpoznania do wyleczenia (lub zgonu). Analiza obejmuje wydatki NFZ, zatem jest analizą kosztów bezpośrednich,nie uwzględniającą wydatków ponoszonych przez chorych.Wyniki. Wydatki związane z leczeniem chorych na raka piersi rosły w latach 2004–2010 w tempie przekraczającymtempo infl acji konsumenckiej i w roku 2010 osiągnęły ok. 500 mln PLN. Wydatki na osobę w tym roku wynosiły średnio32 tys. PLN, przy znaczących różnicach pomiędzy poszczególnymi województwami. Wydatki na osobę zdecydowanieobniżały się z wiekiem — z ok. 67 tys. PLN u chorych 30-letnich do ok. 20 tys. u osób ponad 80-letnich. Wydatki naosoby, które przebyły badanie przesiewowe w kierunku raka piersi, były o około 8–15% niższe niż u pozostałych chorych.Wnioski. Przedstawione dane obrazują skalę obciążenia fi nansowego wynikającego z leczenia raka piersi w Polsce.Dzięki danym gromadzonym w NFZ możliwe jest wyliczenie całkowitych wydatków oraz wykazanie różnic w wydatkachpomiędzy różnymi grupami chorych różniących się miejscem zamieszkania, wiekiem, datą rozpoczęcia leczeniaczy uczestnictwem w badaniach przesiewowych. Powyższe dane pozwalają na bardziej świadome i bezpieczneprojektowanie zmian i modyfi kacji w systemie zwalczania raka piersi.Introduction. Breast cancer is one of the major problems of cancer, althought it is increasingly a treatable disease.The fi ght against breast cancer should have an appropriate infrastructure and provide a clinically eff ective and costeff ective method of treatment. In this case, the knowledge on expenditures is essential (from the perspective of thepayer) and also costs of treatment (in terms of contractor services), so that decisions about expenditures on treatingbreast cancer have been burdened with the least possible risk. Whereas treatment decisions should be based onclinical evidence (evidence-based medicine), management should be based on evidence of an economic nature(evidence-based management). The current analysis contributes to the discussion on proper fi nancial managementin the treatment of breast cancer.Materials and methods. This analysis was based on the National Health Fund (NHF) data, available in the Registerof Diseases’ Treatment system. We analyzed data on about 104,000 patients treated in Poland for breast cancer in the years 2004–2010. That is, on all the patients identifi ed as “confi rmed” in the NHF system during this period. Theentire expenditure on therapy of particular patients have been counted, including expenditure from the beginningof therapy to cure (or death). This analysis includes only NHF expenditure (the direct costs), and does not includecosts incurred by patients.Results. Expenditure related to breast cancer treatment increased between 2004 and 2010 at a rate exceeding therate of consumer infl ation, and in 2010 reached about 500 million PLN. In 2010 expenditure per person averaged32 thousand PLN, with signifi cant diff erences between individual regions. Expenditure per capita decreased stronglywith age — from about 67 thousand PLN in patients aged 30 years, to about 20 thousand PLN in those over 80 yearsold. Expenditure on people who have undergone a screening mammography were about 8–15% lower than in otherpatients.Conclusions. Our data illustrate the scale of the fi nancial burden of treatment of breast cancer in Poland. Usingdata accumulated in the NHF it is possible to calculate the total expenditure, and to demonstrate the diff erences inspending between groups of patients diff ering in place of residence, age, date of commencement of treatment, orparticipation in screening. These data allow for more informed and safe designing of changes and modifi cations inthe system of breast cancer management

Comparison of indicators of the use of insulin and oral diabetes medication in a Polish population of patients in urban and rural areas in the years 2008, 2011 and 2012

introduction. Diabetes is one of the 10 most important chronic diseases in the world. According to the data of the International Diabetes Federation, in Poland 9% of the population between the ages of 20–79 suffer from diabetes. objective. The aim of this study was to investigate the differences in the prevalence of diabetes in urban and rural areas in Poland, and the preparation of a model describing the phenomenon. materials and method. Differences between urban and rural areas were studied for the occurrence of patients treated with diabetes per 100,000 inhabitants, the number of patients, structure of treatment per the used products, and the costs of reimbursement of treatment products between 2008–2012. Urban and rural cases were compared using zip codes. The basis for classifying a patient as being an inhabitant of an urban or rural area was an urban zip code of the declared place of residence. results. Differences were observed both between various areas of Poland, as well as depending on whether the declared place of residence of the patient was urban or rural. Differences between urban and rural areas within the studied period have increased. The difference in the prevalence of diabetes among the inhabitants of Podlaskie, Śląskie or Świętokrzyskie provinces is striking. conclusion. Differences between urban and rural areas which depend on morbidity and detection of patients in the earlier phase of illness, the structures of medical technologies used in the treatment process, the number of purchased pharmaceuticals, enable better monitoring of effectiveness and quality of politics on prevention and treatment of chronic diseases. It is important for the creation of a health policy to devise a system of indicators, which will enable a decrease in the existing differences between regions, and between the urban and rural areas within the provinces

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