Diabetes in Lithuania: A Silent Crisis

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With over 120,000 people whose lives are affected by the disease in Lithuania; diabetes stands as one of the country’s major health issues today. Furthermore, as Marijus Valatka, general manager for Lithuania, Latvia and Estonia of Novo Nordisk – the world leader in insulin and diabetes drugs – explains, “Lithuania was the second lowest ranked country in the Euro Diabetes Index 2014, which positions Lithuania as one of the worst countries in terms of access to diabetes treatment among all the European nations. On top of that, Lithuania has some of the lowest levels of insulin use in Europe, ranking 27th out of 31 European countries.”

“During the last decade, the number of people suffering from diabetes has doubled while, at the same time, the National Health Insurance Fund (NHIF) spending for diabetes treatment has remained stable”

To compound matters, “during the last decade, the number of people suffering from diabetes has doubled while, at the same time, the National Health Insurance Fund (NHIF) spending for diabetes treatment has remained stable over the last five to six years. What is more, the NHIF funds for insulin treatment have been constantly decreasing as a result of various cost containment measures,” posits Valatka.

This situation is made worse by the fact that, “unfortunately, diabetes is not one of the priorities of the Lithuanian Ministry of Health,” continues Valatka. “In order to have a good level of care, a country must not only ensure access to innovative medicinal products but also grant adequate reimbursed treatments and devices to manage diabetes such as insulin pumps, continuous glucose monitoring sensors, and glucose test strips – Lithuanian patients are quite limited when it comes to reimbursement of such devices. This situation causes a worrying concern because self-monitoring of blood glucose is an essential tool for diabetes management.”

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Rasa Verkauskiene, head of the Kaunas Endocrinology Clinic and professor at the Lithuanian University of Health Sciences describes the diabetes situation in Lithuania as “unfortunate and reflective of a greater problem within the governing structure where great long-term results are all too eagerly substituted for quick but usually temporary gain.” She goes on, “Another problem is a lack of understanding of pharmacoeconomic principles in managing chronic diseases, such as diabetes. The field is rapidly changing with new interventions opening new possibilities, and at the same time new data on already available treatments may change the landscape.”

As a regional comparison, Martynas Jocas, marketing director Baltics and general manager for Lithuania for AstraZeneca proffers that “if we take Type Two diabetes – a disease with globally increasing incidence and prevalence rates – we see that Latvia and Estonia’s innovative oral medication usage is already comparable to Nordic countries. In Latvia and in Estonia, the share of novel medications in the non-insulin medicines market is around 25 percent while in Lithuania it is only around five percent.” Jocas continues, “The reason for this is the influence of the reimbursement restrictions in Lithuania and the attitude of the healthcare providers. They believe that everything in Lithuania with diabetes is fine, that diabetes is very well controlled with existing drugs and that they are doing a very good job in keeping the budget flat while in other countries payers are not able to do it. I am not convinced that such an approach – where innovative medications are seen as a threat to the budget and therefore their usage is limited and postponed as much as possible – leads to better outcomes for diabetes patients.”

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In terms of finding solutions to the Lithuanian diabetes problem, Zydrune Visockiene, head of the Center of Endocrinology and associate professor at Vilnius University Hospital Santaros Klinkos, argues that, “since 2014 changes have been made, but I do agree that there are areas in which we still need to improve. The first is diabetes statistics – both collecting and sharing the valid and real data – this is the priority of official institutions as they collect a lot of information. Secondly, we want to see an agreement on a National Diabetes Programme and have it implemented. Thirdly, we would like regular and continuous discussions with official institutions to improve the reimbursement of diabetes treatment in the light of new evidence and finally, we want diabetes to be made a priority in the political agenda and get support for the Government to make the necessary changes.”

Valatka, whose affiliate has seen a few of its innovative drugs reimbursed in Lithuania already, adds that “in order to evaluate how diabetes is managed across the country, a national diabetes registry should be established. Having such a registry would enable the evaluation of antidiabetic medicines’ efficacy as well as costs in local setting.” For Verkauskiene, however, the major sea change needs to be in terms of awareness and utilization of primary prevention. She asserts that “dietary, physical and behavioural intervention before the onset of the disease to prevent its development are extremely important and severely underused tools.”

Writer: Patrick Burton

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