A new report on Laboratory Medicine in Poland highlights the role of laboratory diagnostics in the timely treatment of chronic conditions. Not only can investment in early diagnosis save and improve lives, it can also save money on long-term care.
‘There is not enough data on how health budgets are spent,’ says Jozef Jakubiec, Director General of IPDDL which compiled the report with Deloitte. ‘We wanted to show hard evidence to illustrate to decision-makers that that situation in Poland is considerably worse than in neighbouring countries, such as the Czech Republic.’
Take diabetes, for example. Serious complications from the advanced stages of the condition can include chronic kidney disease (CKD). This, in turn, may lead to a life-long dialysis or kidney transplantation – both of which come at a considerable personal and economic cost.
Some people live with diabetes mellitus without symptoms for many years. Indeed, it may not be until complications arise that their condition is diagnosed. However, by that stage considerable damage may have been done. Even small changes in blood glucose can begin the process of degeneration of blood vessels.
In order to intervene early and with the right treatment, glucose testing is essential. If Poland were to increase glucose testing by 25% a year, savings of PLN 0.5 billion (€0.12 billion) would be made within six years.
For patients with diabetes-related conditions, the annual cost was estimated at PLN 5 (€1.17) in pre-diabetes compared to PLN 9,269 (€2,168) in diabetes with complications (an over 1800-fold difference). ‘The earlier the treatment is taken and monitored regularly, the more effective and less expensive it is,’ the report says.
Prevention is cheaper than cure
For CKD, it’s a similar story: the disease may remain asymptomatic until the last stage of renal failure. ‘There’s a big shift towards CKD because the disease is developing faster when it’s not detected quickly, says Jakubiec.
In the first and second stages of the disease, treatment can be effective; by stage three the goal is to stop progression of the disease; and by stage IV, doctors begin to prepare for dialysis or transplantation required in stage V. Clearly, preventing patients in stages I and II from suffering organ failure in the advanced stages of CKD should be the overarching goal.
The paper provides a detailed breakdown of the costs associated with treating CKD. The average annual cost of treating a CKD patient in the I-III stage was estimated at PLN 120-138 (€28-32) compared to PLN 1,937 (€453) in stage IV and PLN 35,799 (€8,373) in stage V (a nearly 300-fold difference between I and V).
A cost-efficiency analysis published in the report shows that a 25% increase in creatinine testing results in savings to the National Health Fund of PLN 93-197 million (€22-46 million) per year at 2013 prices (direct medical costs).
In Poland, spending on laboratory diagnostic medical devices is around three times lower than the European average. Neighbouring countries such as the Czech Republic spend twice as much.
Jakubiec says the report adds to the evidence-base showing that ‘preventing advanced stages of disease is always cheaper than treating it’. However, a system shift is required, starting with greater use of diagnostic tests in primary care.
‘We have been trying to raise awareness among the public and health professionals for years – including through our Lab Tests Online website,’ he says. ‘But there are some structural changes required to incentivise GPs to order necessary tests.’
GPs can order any of around 60 tests where required. Around 20 of these can be used in combination for the early detection of health problems in seven to eight major disease areas. However, most GPs do not use even these essential tests. One factor at play may be how doctors are paid: GPs receive a fixed fee for each patient they care for so by ordering more tests they reduce the funds available for their clinic.
‘In the Czech Republic, for example, there is a separate budget for lab tests,’ explains Jakubiec. ‘So, if a doctor can justify a test based on hard evidence then they have every reason to do so. In the grand scheme of things, this can lead to savings to the health system.’
Still, there may be some reasons for cautious optimism. The new report has been received by the Health Ministry which has invited IPDDL to a series of roundtable events on the draft proposal for regulation changes to the Laboratory Diagnostics Act. And in August, Poland’s Supreme Audit Office (SAO) published a report on access and financing of lab diagnostics. The SAO report refers in many places to data from the IPDDL/Deloitte report.
‘Today the atmosphere is good but there have been many reports published by different companies and authorities and nothing happened. We will see where and when patients will experience improvements in prevention medicine.’
IPDDL will soon begin a national PR campaign to present the value to patients of early diagnostic information. The econometric approach presented in the report may be valid for other diseases, including cardiovascular disease, Hepatitis B, and throat infections where data can be obtained.