györgy bozsik md semmelweis university faculty of medicine department of neurology budapest
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György Bozsik MDSemmelweis UniversityFaculty of MedicineDepartment of NeurologyBudapest
Migraine management in Hungary
21.09.2007Istanbul, Turkey
Hungary
Inhabitants: 10 million
Capital: Budapest (2 million inhabitants)
GDP per capita: 8815 euro (2005)
Healthcare expenditure as the percentage of GDP (2004)
-Total expenditure on health per capita: 856 USD - Pharmaceutical expenditure on health, % of total expenditure on health: 26 %
- Practising physicians density per 1000 population 4
- active beds density per 1000 population 6
- chronic beds density per 1000 population 2
- MRI units per million population 1,8
- CT scanners per million population 5,7
Organisation for Economic Co-operation and Development (OECD), 2000
Hungary
Austria Czech Rep. Poland Slovakia Hungary Russia
Expected lifetime at birth(men, 2004)
Total health expenditure by financing agent, 2004
Migraine - diagnosis
0
10
20
30
40
50
60
migraine
diagnosed non-diagnosed
Spierings ELH, 2002
05
101520253035404550
Adelman JU et al,2000
Patient visits the outpatient service
Headache historyDanger signals ? YES Refer to specialist,
Determine secondary headache NO disorder ( consultation,physical, examination, neuroimaging etc.)
Physical examinationabnormality ? YES
NO
Specific disease ?Unusual, rare disease ? YES Reconsider the diagnosis of
symptomatic/secondaryNO headache disorder
Treatment of primary headache disorder (Silberstein SD, Lipton RB, Goadsby P, 1998)
• Migraine management is based on the diagnostic criteria of the International Headache Society (2nd edition, 2004)
• Diagnostic algorhythm for headaches
Acute treatment of migraine with triptans in Hungary
-prescripton is required-25% of price is reimbursed, but only if prescribed by a neurologist-NEW: 100% reimbursed in exceptional cases (low income patients, limited quantity)-available triptans:
• Barriers: -price -self medication with OTC products -low awareness
triptan full price (euro)
sumatriptan (6x100mg) 49
sumatriptan gen. (6x100mg) 24
eletriptan (6x40mg) 28
zolmitriptan (3x2,5mg) 19
Headache managementin Hungary
• First headache outpatient service at Semmelweis Dept. of Neurology in 1976
• Regular postgraduate seminars since 1977• Headache section of the Society of Neurologists and Psychiatrists of Hungary in 1990• Annual conferences since 1994• Cephalalgia Hungarica since 1994• Headache centres (22) since 1995 • Hungarian Headache Society (members > 200) since 1996• Treatment protocol of primary headache disorders 2004• Internet:www.fejfajas-tarsasag.hu
Population of territories covered by headache outpatient services
average: 228 750 ( range: 50 000-450 000)altogether: 3 360 000
050000100000150000200000250000300000350000400000450000
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
population
Ways of improvement
• Key activities:– Increase the awareness of patients– Incourage the establishing of a patient
association– Increase graduate / postgraduate training for
doctors• International cooperation:
– Increase cooperation between national headache societies
– Initiate an East-European study about migraine and its management?
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