mental health care reform in lithuania: the main trends and financing ona davidonienė state mental...
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MENTAL HEALTH CARE MENTAL HEALTH CARE
REFORM IN LITHUANIA: REFORM IN LITHUANIA:
THE MAIN TRENDS AND FINANCINGTHE MAIN TRENDS AND FINANCING
Ona DavidonienėState Mental Health Centre
MENTAL DISORDERS IN LITHUANIA (per 100 000)
2408,6
2287,5
2170,12116,6
2639,5
2090,8
2000
2100
2200
2300
2400
2500
2600
2700
1996 1997 1998 1999 2000 2001
Psychiatric disorders
4645,5
4288,9
4210,94175,14194,2
4217,8
1996 1997 1998 1999 2000 2001
Total number of mentaldisorders
Data of State Mental Health Centre of Lithuania
SUICIDES IN LITHUANIA 1930-1940 AND 1986-2001
(per 100 000)
44,1
77,2
15,0
0
10
20
30
40
50
60
70
80
90
19
30
19
31
19
32
19
33
19
34
19
35
19
36
19
37
19
38
19
39
19
40
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
Su
icid
es
pe
r 1
00
00
0 p
op
ula
tio
n Male
Female
Total
SUICIDES IN URBAN AND RURAL AREAS IN LITHUANIA 1930-1940 AND 1980-2001
(per 100 000)
34,8
62,8
0
10
20
30
40
50
60
70
1930
1932
1934
1936
1938
1940
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
Su
icid
es p
er 1
00 0
00 p
op
ula
tion Rural area
Urban area
GROWTH OF DRUG ADDICTION MORBIDITY IN LITHUANIA
(per 100 000)
Data of State Mental Health Centre of Lithuania
117,2
95,383,377,577,4
63,4
34,026,1
0
40
80
120
160
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
Mo
rbid
ity
pe
r 1
00
00
0 p
op
ula
tio
n
Drug and toxic substances addicts
MENTAL HEALTH CARE REFORM
Pre-reform state
In-patient treatment
Outpatienttreatment
Reform
Reform target
In-patient treatment
Outpatienttreatment
MENTAL HEALTH ACTS AND PROGRAMMES
1.Mental Health Care Act (1995) (http://www.vpsc.lt).
(Amendments made in 2001).
2.Narcotic and Psychotropic Substances Control Act
(1998) (http://www.vpsc.lt).
3.State Programme on Mental Disease Prevention
(1999) (http://www.vpsc.lt).
4.National Drug Control and Drug Use Prevention
Programme (approved in 1999).
5.State Alcohol Control Programme (approved in 1999).
MENTAL HEALTH CENTRES STAFF IN LITHUANIA
MENTAL HEALTH CENTRES
1 January, 1999
1 January, 2000
1 January, 2001
1 January, 2002
49 55 59 61
Specialists for mental health
Psychiatrists 102,25 105,5 117,25 123,0Child psychiatrists 26,25 36,0 39,0 40,36Nurses 125,75 147,5 156,25 165,15Social workers 14,5 65,25 98,0 108,5Psychologists 3,0 26,5 57,25 66,6
Specialists for addictions
Psychiatrists 36,75 30,5 34,75 34,25Nurses 22,25 44,5 39,75 40,85Social workers 6,5 20,5 23,0 25,8Psychologists 2,5 7,0 10,25 12,35
Data of State Mental Health Centre of Lithuania
PRESCRIPTION COVERAGE OF PSYCHOTROPICS IN LITHUANIA
Schizophrenia,
schizoaffective disorders
(F20; F25)
AmisulprideClozapineOlanzapineRisperidone
100 % coverage
FlupentixolFluphenazineHaloperidolTrifluoperazineZuclopenthixolLithiumTrihexyphenidylum
80 % coverageSchizotypal and
delusional disorders
(F21 - F29)
Amisulpride
Olanzapine
Risperidone
Haloperidol Fluphenazine Trifluoperazine Zuclopenthixol Flupentixol Citalopran Fluvoxamine Lithium
Amitriptyline Paroxetine TrihexyphenidylumFluoxetine Sertraline
Moderate and severe
affective disorders
(F30.2; F31.1-F31.5;
F32.1-F32.3; F33.1-F33.3)
Citalopran Fluvoxamine FluoxetineAmitriptyline Paroxetine SertralineHaloperidol Trifluoperazine Lithium Mirtazapine Reboxetine Trihexyphenidylum
Dementia
(F00 (G30); F01-F03)
Amitriptyline Donepezil MelperoneHaloperidol Trifluoperazine Lithium Memantine Tiapridal Trihexyphenidylum
50 % coverage
Organic psychotic disorders
(F06)
Citalopram FluoxetineFluphenazineFluvoxamineHaloperidolMirtazapineParoxetineTrifluoperazineSertralineLithiumTrihexyphenidylum
EUROPE (NORTH AND SOUTH) – N5A ANTIPSYCHOTIC MARKET
333.9
1206.0
0
200
400
600
800
1000
1200
1400
Q1/97
Q2/97
Q3/97
Q4/97
Q1/98
Q2/98
Q3/98
Q4/98
Q1/99
Q2/99
Q3/99
Q4/99
Q1/00
Q2/00
Q3/00
Q4/00
Q1/01
Q2/01
Q3/01
Q4/01
Q1/02
Sa
les
$ M
N5A9 Conventionals
N5A1 Atypicals
Source : IMS Health WinEI Q1/02 (Actual Exchange Rates)Countries and Panels included :- UK; HOLLAND; SWEDEN; POLAND; DENMARK; IRELAND; CZECH REP; GERMANY; FRANCE; SPAIN; ITALY; SWITZERLAND; AUSTRIA; GREECE; PORTUGAL; BELGIUM
NORTH AMERICA – N5A ANTIPSYCHOTIC MARKET
172
5548
0
1000
2000
3000
4000
5000
6000
Q1/97
Q2/97
Q3/97
Q4/97
Q1/98
Q2/98
Q3/98
Q4/98
Q1/99
Q2/99
Q3/99
Q4/99
Q1/00
Q2/00
Q3/00
Q4/00
Q1/01
Q2/01
Q3/01
Q4/01
Q1/02
Sa
les
$ M
N5A9 Conventionals
N5A1 Atypicals
Source : IMS Health WinEI Q1/02 (Actual Exchange Rates)Countries and Panels included :- USA; CANADA
LITHUANIA – N5A ANTIPSYCHOTIC MARKET
0,357
7,374
0,0
2,0
4,0
6,0
8,0
Sal
es L
T M
N5A9 ConventionalsN5A1 Atypical
ATYPICAL ANTIPSYCHOTICS PRESCRIPTION GROWTH OVER TIME
0
5000
10000
15000
20000
25000
Nu
mb
er
of
Rx
(0
00
s)
Others
Perospirone
Amisulpride
Ziprasidone
Clozapine
Risperidone
Seroquel
Olanzapine
*Market Definition = N5A1 Atypical Antipsychotics
Markets = USA, UK, Canada, Netherlands, Germany, Italy, Japan
Source : IMS Health MIDAS Dataview MAT Q1 2002
PRESCRIPTION MARKET SHARE VS. MAIN COMPETITORS
39,1
32,0
26,5
21,5
48,8
38,7
69,7
4,9
11,9
6,4
43,6
4,3
32,0
4,8
35,8
18,2
9,9
6,5 5,6
16,6
6,6
46,6
35
40,7
23,3
6
17,6
10,89,7
4,5 6,57,9
7,6
0
10
20
30
40
50
60
70
80
USAUK
Lithuan
ia
Ger
man
y
Canada
Italy
Japan
% R
x M
arke
t S
har
e
Olanzapine SeroquelRisperidone ClozapineZiprasidone AmisulpridePerospirone Others
Source : IMS Health MIDAS Dataview MAT Q1 2002
*Market Definition = N5A1 Atypical Antipsychotics
PRESCRIPTION COVERAGE EXPENSES IN LITHUANIA
36,333,752 (12%)
25,8 (8%)
430
321355
324
0
100
200
300
400
500
1998 1999 2000 2001
Ex
pe
nd
itu
re L
T M
expenditure for covered medications, mln. Lt covered psychotropic medications, mln. Lt.
IN-PATIENT PSYCHIATRIC TREATMENT IN LITHUANIA
32,431,9
32,532,8
34,6
30
31
32
33
34
35
1997 1998 1999 2000 2001
Av
ara
ge
ho
sp
ita
l sta
y (
in d
ay
s)
Avarage hospital stay
27,0
23,2
33,935,6
39,8
20
25
30
35
40
45
1997 1998 1999 2000 2001
Re
ad
mis
sio
ns
(%
)Yearly readmissions (%)
Data of State Mental Health Centre of Lithuania
TOTAL NUMBER OF BEDS IN MENTAL HOSPITALS IN LITHUANIA
371838093824
4150
5380
3510
3000
4000
5000
6000
1991 1997 1998 1999 2000 2001
Nu
mb
er
of
be
ds
Data of State Mental Health Centre of Lithuania
NUMBER OF DISABLED DUE TO SCHIZOPHRENIA AND MENTAL RETARDATION
IN LITHUANIA
11141 11138 11217 11286
10771
82028219
800480797745
7500
8500
9500
10500
11500
1997 1998 1999 2000 2001
Schizophrenia
Mental retardation
Data of State Mental Health Centre