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80 Plasma KCE Reports 120 Table 31: Amounts of immunoglobulins prescribed by paediatricians in 2008 and proportion of the total amount prescribed per hospital Flemish Flemish French French All academic paediatricians 14.61 kg 7.7% 12.28 kg 11.8% 2.44 kg 9.8% 3.05 kg 17.7% 0.96 kg 5.9% 1.82 kg 23.0% 0.96 kg 5.2% 1.54 kg 11.8% 0.89 kg 7.5% 1.00 kg 7.6% 0.84 kg 11.4% 0.66 kg 20.5% 0.61 kg 1.9% 0.56 kg 7.7% 0.58 kg 7.1% 0.51 kg 5.7% 0.53 kg 2.8% 0.50 kg 6.8% All Belgian paediatricians 54.62 kg 5.9% Table 32: Amounts of immunoglobulins prescribed by rheumatologists in 2008 and proportion of the total amount prescribed per hospital All academic rheumatologistss Flemish Flemish French French 2.52 kg 1.3% 0.20 kg 0.2% 4.45 kg 36.5% 2.19 kg 61.5% 1.51 kg 4.5% 1.42 kg 12.9% 1.21 kg 35.7% 1.06 kg 36.0% All Belgian rheumatologists 18.89 kg 2.1% Table 33: Amounts of immunoglobulins prescribed in intensive care units for adults in 2008 and proportion of the total amount prescribed per hospital Flemish Flemish French French All academic IC units for adults 4.04 kg 2.5% 2.92 kg 3.8% 1.47 kg 4.6% 0.83 kg 17.1% 0.63 kg 10.7% 0.65 kg 6.7% All Belgian IC units for adults 20.55 kg 2.5% Table 34: Amounts of immunoglobulins prescribed by gastro-enterologists in 2008 and proportion of the total amount prescribed per hospital Flemish Flemish French French All academic gastroenterologists 2.09 kg 1.1% 0.54 kg 0.5% 1.11 kg 12.1% 0.63 kg 7.8% All Belgian gastroenterologists 7.71 kg 0.8% Table 35: Amounts of immunoglobulins prescribed by surgeons in 2008 and proportion of the total amount prescribed per hospital All academic general surgeons Flemish Flemish French French 1.47 kg 0.8% 1.37 kg 1.3% 2.37 kg 18,0% All Belgian general surgeons 6.50 kg 0.7%
KCE Reports 120 Plasma 81 Table 36: Amounts of immunoglobulins prescribed by hospital general practitionners (GPs) in 2008 and proportion of the total amount prescribed per hospital Flemish Flemish French French All GPs in academic hospitals 1.98 kg 1.0% 0.16 kg 0.2% 1.03 kg 92.3% 1.02 kg 15.8% All Belgian general practitioners in hospitals 5.56 kg 0.6% Table 37: Amounts of immunoglobulins prescribed by cardiologists in 2008 and proportion of the total amount prescribed per hospital Flemish Flemish French French All academic cardiologists 3.11 kg 1.6% 0.50 kg 0.5% 0.64 kg 16.1% All Belgian cardiologists 6.46 kg 0.7% Table 38: Amounts of immunoglobulins prescribed by gynecologists in 2008 and proportion of the total amount prescribed per hospital Flemish Flemish French French All academic gynecologists 0.96 kg 0.3% 0.00 kg 0.0% 0.24 kg 12.2% 0.77 kg 4.4% 0.19 kg 1.0% 0.23 kg 3.9% All Belgian gynecologists 3.04 kg 0.3% 3.3.2.4 Discussion on IG consumption Data on IG consumption in Belgium indicate similar patterns than those found in other countries: IG consumption is increasing over time, four main specialties consume the majority of IG, the use of IG is heterogeneous across hospitals and some hospitals consume a high IG amount in specialties that are not related to the authorized or reimbursed indications. Two additional findings in Belgium have been revealed by the KCE survey: 1. A high amount of IG is prescribed by lung specialists, though this cannot be justified by current reimbursed indications or available evidence, as no respiratory pathology is included in the current indications for IG (except for specific immune deficiencies with repeated respiratory tract infections). This was not observed in any of the academic hospitals but was predominant in 11 Flemish and one Walloon hospitals. At international level, this was only reported in one region in the New Zealand study. As we did not have access to data on IG consumption per indication, we could not explain this prescription with available data. This finding deserves further investigation. 2. The survey showed wide variations in prescription patterns between academic and non-academic hospitals. A major finding is that a number of non-academic hospitals prescribe significant IG amounts for four other specialties (surgery, obstetrics, gynaecology and gastro-enterology) that are not related to reimbursed indications - or to other indications for which a benefit of IG has been proven. This unexpectedly high IG use is not observed in academic hospitals. Unexpected patterns of IG use in some hospitals or geographical areas were also observed in New Zealand where one region used 11-fold more IG per capita for obstetric purposes than the other regions. The Toronto study also noticed that individual physicians with specific clinical interest were responsible for large proportions of the total IG prescribed. The reasons for the overall increase in IG consumption over the recent years could not be investigated based on these Belgian data. We had no access to data allowing us to determine for which indications IG has been prescribed over time.
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KCE Reports 120B Plasma i PRÉFACE
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