Ewa Sek, general manager at ResMed Poland, explains the crucial role of ResMed in raising awareness on sleep apnea, COPD and other respiratory-related conditions in Poland and highlights the important investments that should be made to increase the diagnostics capabilities as well as to reimburse telemedicine and device accessories.
ResMed has a unique focus on sleep apnea, COPD and other respiratory conditions. How would you characterize this market in Poland?
“Sleep apnea is connected mainly with cardiac diseases like hypertension, arrhythmias, stroke or diabetes. Also, daily sleepiness is an important issue, particularly in case of drivers. According to data, even 25% of car accidents could result from sleep apnea and daily sleepiness. “
This market is very different from the other countries we are present in because in most Western European countries like France, Germany or Italy, homecare providers dealing with sleep and home ventilation act rather as technical service providers. In Poland, homecare providers take care only for home ventilated patients and they remain under the care of healthcare professionals. Depending on the patients’ conditions, they can be visited by doctors and nurses from twice per month to once every quarter.
In the case of sleep apnea and unlike in other countries, patients are not under the care of homecare providers as CPAP devices are part of the reimbursement system. The National Health Care Insurance refunds a given amount of money for the basic CPAP device, but in case of a device with additional features, the price is higher, and patients must pay the difference from their own pocket. Patient could get reimbursement of the CPAP machine and mask once every five years. Unfortunately, during this period there is no reimbursement of mask and other accessories. This situation has a huge influence on patients’ compliance. Not all patients are able to bear the costs of masks or accessories during the five years period, so in many cases they simply stop the treatment. Also, patients looking for lower prices buy devices, which finally are not acceptable for use due to noise, low quality of treatment, lack of expected efficiency etc.
Patient pathway from diagnosis to treatment is relatively long. First, the patient has to get referral from GP to pulmonologist, then he has to wait for the visit at pulmonologist and then for a sleep study. In some counties, the patient must wait even two years for the sleep study. After diagnosis, he needs to wait for a visit at the pulmonologists. The doctor, in case of sleep apnea, could give the prescription for a CPAP device. The patient has to get approval for reimbursement from the National Health Care Insurance and then can get the device in the Medical Shop.
How many patients are diagnosed each year?
For conditions like sleep apnea, a full polysomnography (PSG) is required. The issue is that the number of sleep labs in Poland is very limited. We have about 100 of them with an average of 1.8 beds.
Therefore, it is critical to increase the capacity of the sleep labs to diagnose more patients. Indeed, with a population of 38 million people, Poland has around 1,3 million people living with sleep apnea. Every year, the government reimburses a given number of studies and in 2017, around 20 000 sleep studies were reimbursed. This number is growing year on year so in 2018, we are expecting around 24 000 tests to be conducted, but if we look at the population of patients with sleep apnea this numbers are still very far from the needs.
Another challenge that we are facing is the willingness of patients to be treated. Indeed, among all the tests, not all patients are positively diagnosed, which is reducing the final pool of patients to 70 percent. From this final group, only about 60% of the patients will go to medical shops and buy the devices. It can be explained by various reasons, such as the complications the device will bring to their sleeping habits or by the high price of the device and its accessories. If we look at all data officially published on the web page of our National Health Care Insurer, we believe that around 60 000 patients bought the device, a lot less than the prevalence numbers. How many of them are still on treatment? We do not know. The dropout rate is rather high and according to doctors, it could be even 30-60% in the first year of the therapy.
How are you participating in improving the situation?
We are the only company in this therapeutic area in Poland using digital marketing to raise awareness on the condition. We are trying to support patients by providing them with all necessary information to understand the problem of sleep apnea and importance of treatment. Sleep apnea is connected mainly with cardiac diseases like hypertension, arrhythmias, stroke or diabetes. Also, daily sleepiness is an important issue, particularly in case of drivers. According to data, even 25% of car accidents could result from sleep apnea and daily sleepiness. We have EU Directive concerning testing and monitoring of the drivers, but no clear pathways for this process were implemented in Poland. Our main goal is to educate patients, and in this context, we organized public relation activities with press conferences and articles to get more attention on the conditions. With more visibility in the media, we are motivating more patients to understand sleep apnea and its consequences.
Considering that patients should use the devices for more than four hours each night in order to benefit from the treatment, we aim to offer them access to the best devices available, providing the most comfortable algorithms for the patients’ compliance. In order to continuously increase the compliance of the patients, ResMed has developed an application for patients, called myAir, which is a support application. Every day patients get on app their sleep parameters and are rewarded for compliance. Also, they can watch educational films and use dedicated tips on device usage. To date, we have more than 1 000 patients using this application in Poland.
ResMed has always had a constant growth globally. What is the situation in Poland?
Considering that we have limited capacity of the sleep labs, and limited allocation of budget for reimbursement, the market cannot grow as quickly as it should from the prevalence point of view. Another important point is that the devices have an important final cost so many patients in Poland decide to go for a cheaper product, which is often unfit for their condition. However, ResMed managed to offer its entire portfolio in the country. For the diagnostic of sleep apnea, our main product is PSG from Nox company for hospitals and private outpatient clinics. We are able to sell them or rent them to the centers, depending on their capabilities. Another service that we are offering is our AirView platform for doctors, where they can remotely control the patients’ sleep data. Through the AirView platform, we monitor more than 6 000 patients and it is a better solution for patients allowing them to save a trip to the hospital by getting their devices modified according to the evolution of their condition.
What type of partnerships have you developed to better support the patients?
We do not have direct contact to the patients as we sell to medical shops, so we are focused on training doctors and medical shops’ employees. As for doctors’ education, we are visiting them directly and organizing once a year, the ResMed Academy. For this special event, we are inviting foreign speakers and presenting the latest reports on sleep apnea diagnostic and treatment.
In what way is ResMed the ideal partner for all patients suffering from sleep apnea, COPD and other respiratory diseases?
I believe we are offering unique solutions linked to digital platforms like AirView or myAir, which our competitors do not have. We have high quality products and outstanding algorithms to answer the need of each individual patient. For example, we have developed the only device dedicated to women.
We are able to deliver diagnostic solutions and telemonitoring as well, which can help establish us as a key partner in this area. Indeed, telemonitoring is accessible in the country but my goal is now to have it reimbursed within the next few years. Indeed, Poland is experiencing a shortage of medical staff and telemedicine will highly support healthcare professionals as they will control the treatment of more patients in less time. In some Polish counties, patients must wait up to two years in order to receive a diagnostic for sleep apnea. Moreover, a study from PwC in Finland and Germany actually showed that telemonitoring can also increase the compliance by allowing a better patients follow-up and less cost for patients. I believe that this solution will help alleviate the burden on the healthcare system.
What are the goals that you have set for the affiliate for the next few years?
My key priority is the reimbursement of telemedicine as it represents the future. My other focus is the reimbursement of accessories for the medical devices. Indeed, nowadays, patients get the device for five years but as soon as a piece breaks (mask, tube…), they have to pay by themselves which represents an important cost and could have a strong influence on compliance.
What is your recipe for success?
To achieve your goals, you must put as much effort and engagement as possible. When I started, I developed a strong fighting spirit in order to be successful in the end. In the end, it is really about hard work and perseverance.