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74 Plasma KCE Reports 120 Key points • In other industrialized countries, around half of the total amount of immunoglobulins is used to treat immuno-haematological diseases, and around one third is used to treat neurological and neuro-muscular diseases. • Some specialities or indications that are usually not included in recommendations consume an unexpectedly high amount of IG, with large variations across hospitals and geographical areas. Individual physicians or clinics may impact on large proportions of the total IG prescribed • A few diseases consume a high proportion of the total IG. For instance, four diseases (chronic inflammatory demyelinating polyneuropathy, primary and secondary immune deficiencies and idiopathic thrombocytopenic purpura) consumed in average two third of the total IG amount. Three of these diseases require long term treatment with IG. 3.3.2 Consumption in Belgium 3.3.2.1 Methods Data on IG use in Belgium were collected from two sources: 1. Data on the period January 2004 - June 2007 from the National Institute for Health and Disability Insurance (INAMI/RIZIV) on the IG amounts reimbursed, per quarter; 2. Data on the year 2008 on IG used by hospitals (reimbursed or not) and collected by an ad-hoc survey. The KCE carried out a survey in March-June 2009 addressed to all pharmacists responsible for hospital pharmacies in Belgium, with the collaboration of the two regional associations of hospital pharmacists. We requested data on the amount of each IG brand product (per label and dosage) used in 2008, by medical specialty of the prescriber, based on the last three numbers of the INAMI/RIZIV codes. All nonresponding hospitals that had consumed >1 500 gr or spent >60 000€ for IG in 2006 were then contacted personally. Data were then analyzed by summing all brand products expressed in grams. Distribution per hospital, medical specialties and type of producer (CAF and non-CAF) are presented. Though data come from two non-fully comparable sources, we have compared data over the 2004-2008 period to identify trends. Information on the indications for which IG has been prescribed is not available. This survey does not aim at assessing the relevance of IG prescription in hospitals. 3.3.2.2 Overall IG amounts used in 2004-2008 INAMI/RIZIV data for the 2004-2006 period have been presented under “Use of plasma derivatives in Belgium” and are compared below to the 2008 data (Figure 7). The KCE received data on 2008 IG amounts used from 102 hospitals reporting a total use of 919.6 kg of IG, all products combined. These 102 hospitals represent a response rate of 82% on the 125 hospitals that reported IG use in 2006 and accounted for as much as 99% of national IG use in 2006.
KCE Reports 120 Plasma 75 Figure 7: Yearly quantities of IG consumed during the period 2004-2008 1,000,000 gr 800,000 gr 600,000 gr 400,000 gr 200,000 gr 0 gr IG amount trend (linear) 2004 2005 2006 2007 2008 Sources: INAMI (2004-2006) and KCE survey (2008) Figure 7 shows the yearly increase of IG consumed over the period 2004-2008 and its linear trend. Data on 2007 are only available for the first two quarter of 2007. It must be noted that the two data sources are not fully comparable: 2004-2006 data cover reimbursed IG data provided by INAMI/RIZIV in all Belgian hospitals; 2008 data collected by the survey cover reimbursed and non-reimbursed IG reported by Belgian hospitals representing 99% of IG use in 2006. However, we observed that the 2008 estimate fits with the linear trend on the 2004-2006 data. Figure 8 presents the evolution (per quarter) of intravenous IG (IVIG) used, per producer (CAF-DCF and other producers). The systematically lower consumption in the third quarter may be explained by the discontinuation of IG supplementation in mild immune deficiencies during summer (see Patterns of use). The proportion of CAF-DCF IVIG used increased over the period (except in 2007) to reach 54.4% of all IVIG in the second quarter of 2008. In Figure 9, the IG consumption over the years 2004, 2006 and 2008 is compared for the 20 hospitals showing the highest IG consumption. The absolute amounts of IG used are not compared across hospitals by level of activity, by lack of suitable criteria or indicator. But the comparison of trends across hospitals show divergences in IG consumption trends over this 5 year period: some hospitals have nearly doubled their IG use (hospitals 10, 12 and 17), others showed a milder increase or a relative stabilization of IG use, and a minority of them have decreased IG use from 2004 to 2008.
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KCE Reports 120B Plasma i PRÉFACE
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KCE Reports 120B Plasma iii MÉTHOD
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KCE Reports 120B Plasma v En ce qui
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KCE Reports 120B Plasma vii RECOMMA
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KCE Reports 120 Plasma 1 Scientific
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KCE Reports 120 Plasma 3 GLOSSARY A
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KCE Reports 120 Plasma 5 1 INTRODUC
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KCE Reports 120 Plasma 127 APPENDIX
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KCE Reports 120 Plasma 137 6 REFERE
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KCE reports 1. Efficacité et renta
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73. Financement du programme de soi
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