Epidemiology of multiple myeloma in Poland in the years 2008-2017.

Introduction: Multiple myeloma is the third most common blood cancer in Europe and accounts for approx. 10-15% of these cancers. The objective of this study was to determine the incidence, prevalence, mortality and survival in multiple myeloma (ICD code: C90.0) patients in Poland in the years 2008-2017. Material and methods: The analysis used the data on healthcare services provided to patients with multiple myeloma defined with the ICD-10 (International Statistical Classification of Diseases and Related Health Problems) code C90.0 and reported by healthcare entities to the National Health Fund (NFZ). Results: In 2009, the C90.0 incidence per 100,000 inhabitants was 6.4, while in 2017 it was 8.3. The prevalence in the same period increased by 76%, from 13.6/100,000 to 23.9/100,000. The mortality to prevalence ratio gradually decreased from 78% in 2008 to 22.8% in 2017. The 1-year, 3-year and 5-year survival rates in patients with this diagnosis made in the years 2009 and 2013 were 70.5%, 51.5% and 40.2% versus 78.4%, 60.3% and 48.3%, respectively. Conclusions: The incidence and prevalence of multiple myeloma and survival rates in Poland were continuously increasing in the studied period. These trends may result from the aging of Polish society, better recognisability of multiple myeloma and/or improved access to increasingly more effective therapies in Poland. The impact of these factors on the epidemiology of multiple myeloma requires further studies.

Patient care efficiency in primary healthcare - pilot study in Medical and Diagnostical Centre.

In Poland, there is a niche that can be filled with original research in the area of performance indicators of individual health care professionals. AIM: The aim of the study was the empirical verification of original effectiveness indicators and the identification of the degree of patient care effectiveness of selected primary health care professionals with the application of the developed indicators. MATERIALS AND METHODS: The study population consisted of physicians employed in the primary care in Medical and Diagnostic Centre (MDC) in Siedlce, Poland. The final study sample consisted of 29 respondents. 14 original indicators in three areas: structure, process and effect were developed and verified. RESULTS: The distribution of indicator values for the physicians included in the study demonstrated a diverse level of their effectiveness. The factor analysis performed for the 14 original indicators demonstrated that a highly reliable scale can be created out of 5 of the original indicators. CONCLUSIONS: In our pilot study we assessed the reliability of the designed tools. However, unfortunately, our research did not offer the opportunity to identify any dependencies of variables. A study on a larger sample of physicians would therefore be needed.

Overall survival of patients with EGFR mutation-positive non-small-cell lung cancer treated with erlotinib, gefitinib or afatinib under drug programmes in Poland - real-world data.

INTRODUCTION: The aim of the study was to estimate the overall survival of patients with EGFR mutation-positive non-small-cell lung cancer treated with erlotinib, gefitinib or afatinib. MATERIAL AND METHODS: Real-world patients who received afatinib, erlotinib or gefitinib between 1 July 2012 and 30 October 2017 were analysed in five subgroups. RESULTS: Among 267 patients treated with afatinib financed as the first line of treatment, 76 (28.46%) deaths occurred. Median observation time was 12.8 months (95% CI: 11.2-13.9). Median OS was 22.8 months (95% CI: 19.2-27.1). Among 83 patients who received erlotinib financed exclusively as the second line of treatment the number of deaths was 74 (89.16%). Median observation time was 64.3 months (95% CI: 60.4-64.6). Median OS was 16 months (95% CI: 13.2-22.9). Among 622 patients who received erlotinib financed both as first and second line treatment, there were 400 (64.3%) deaths. Median observation time was 33.3 months (95% CI: 31.2-37.6). Median OS was 17.8 months (95% CI: 16.4-19.7). Among 137 patients who received gefitinib financed only as the first line of treatment, there were 128 (93.4%) deaths. Median observation time was 58.3 months (95% CI: 49.4-62.5). Median OS was 16 months (95% CI: 13.8-19.7). Among 348 patients who received gefitinib financed both as the first and second line of treatment the number of deaths was 208 (59.8%). Median observation time was 23.7 months (95% CI: 20.7-28.7). Median OS was 15.5 months (95% CI: 12.9-17.5). CONCLUSIONS: Our real-world data regarding OS confirm the benefits found in clinical trials from the use of afatinib, erlotinib or gefitinib. However, the lower overall survival rate of Polish patients compared to similar studies from other research centres suggests the need for deeper investigation of this issue.

Real-World Evidence of Patient Outcome Following Treatment of Advanced Gastrointestinal Stromal Tumor (GIST) with Imatinib, Sunitinib, and Sorafenib in Publicly Funded Health Care in Poland.

BACKGROUND This study aimed to undertake an analysis of ten years of real-world evidence (RWE) on overall survival (OS) following treatment of advanced gastrointestinal stromal tumor (GIST) with imatinib, sunitinib, and sorafenib using data from the Polish National Health Fund. MATERIAL AND METHODS Data from the Polish National Health Fund, the sole Polish public payer, identified 1,641 patients with advanced GIST who were treated with imatinib (n=1047), sunitinib (n=457), and sorafenib (n=137). The differences in overall survival (OS) were analyzed. RESULTS For patients with advanced GIST, the median follow-up time for patients treated with imatinib was 71 months (95% CI, 64.8-79.2), the median OS was 56.9 months (95% CI, 50.4-61.2), with survival at 12 months (89.5%), 24 months (77.9%), 36 months (66.9%), and 60 months (48.4%). The median follow-up time for patients treated with sunitinib was 41.4 months (95% CI, 34.6-49.3), the median OS was 22.8 months (95% CI, 19.2-26.8), with survival at 12 months (68.2%), 24 months (47.1%), and 36 months (31%). The median follow-up time for patients treated with sorafenib was 17.4 months (95% CI, 14.6-22.9), the median OS was 16.9 months (95% CI, 13.7-24.3), with survival at 12 months (61.9%), at 24 months (36.2%), and at 36 months (16.8%). CONCLUSIONS Real-world data collected in a ten-year period confirmed the effectiveness of the use of imatinib, sunitinib, or sorafenib for the treatment of advanced GIST and was comparable with the findings from clinical trials.

ANALYSIS OF TRENDS IN LIFE EXPECTANCIES AND PER CAPITA GROSS DOMESTIC PRODUCT AS WELL AS PHARMACEUTICAL AND NON-PHARMACEUTICAL HEALTHCARE EXPENDITURES.

Life expectancy is a common measure of population health. Macro-perspective based on aggregated data makes it possible to approximate the impact of different levels of pharmaceutical expenditure on general population health status and is often used in cross-country comparisons. The aim of the study was to determine whether there are long-run relations between life expectancy, total healthcare expenditures, and pharmaceutical expenditures in OECD countries. Common trends in per capita gross domestic products (GDPs) (excluding healthcare expenditures), per capita healthcare expenditures (excluding pharmaceutical expenditures), per capita pharmaceutical expenditures, and life expectancies of women and men aged 60 and 65 were analyzed across OECD countries. Short-term effect of pharmaceutical expenditure onto life expectancy was also estimated by regressing the deviations of life expectancies from their long-term trends onto the deviations of pharmaceutical and non-pharmaceutical health expenditures, as well as GDP from their trends. The dataset was created on the basis of OECD Health Data for 34 countries and the years 1991-2010. Life expectancy variables were used as proxies for the health outcomes, whereas the pharmaceutical and healthcare expenditures represented drug and healthcare consumption, respectively. In general, both expenditures and life expectancies tended to increase in all of the analyzed countries; however, the growth rates differed across the countries. The analysis of common trends indicated the existence of common long-term trends in life expectancies and per capita GDP as well as pharmaceutical and non-pharmaceutical healthcare expenditures. However, there was no evidence that pharmaceutical expenditures provided additional information about the long-term trends in life expectancies beyond that contained in the GDP series. The analysis based on the deviations of variables from their long-term trends allowed concluding that pharmaceutical expenditures significantly influenced life expectancies in the short run. Non-pharmaceutical healthcare expenditures were found to be significant in one out of four models (for life expectancy of women aged 65), while GDPs were found to be insignificant in all four models. The results of the study indicate that there are common long-term trends in life expectancies and per capita GDP as well as pharmaceutical and non-pharmaceutical healthcare expenditures. The available data did not reveal any cause- effect relationship. Other factors, for which the systematic data were not available, may have determined the increase in life expectancy in OECD countries. Significant positive short-term relations between pharmaceutical expenditures and life expectancies in OECD countries were found. The significant short-term effect of pharmaceutical expenditures onto life expectancy means that an increase of pharmaceutical expenditures above long-term trends would lead to a temporary increase in life expectancy above its corresponding long-term trend. However, this effect would not persist as pharmaceutical expenditures and life expectancy would converge to levels determined by the long-term trends.