ANTRAG Zusammenfassung und HTA-Literatur

Transcription

ANTRAG Zusammenfassung und HTA-Literatur
ASA
Assoziation Schweizerischer Ärztegesellschaften für Akupunktur
und Chinesische Medizin
Sekretariat:
Postfach, CH-8575 Bürglen
Telefon 071 634 66 19, Telefax 071 634 66 18
E-Mail [email protected]
Internet http://www.akupunktur-tcm.ch
Zusatzinformationen im Schlussbericht Programm Evaluation
Komplementärmedizin PEK:
http://www.bag.admin.ch/themen/krankenversicherung/00263/
00264/04102/index.html
Summary
Traditional Chinese Medicine (TCM) was reimbursed by the statutory health insurance in
Switzerland („Obligatorische Krankenpflegeversicherung“ (OKP)) between 2000 and 2005. A
project was set up specifically to evaluate TCM, as well as other 4 systems and methods of
complementary medical care from a scientifically sound perspective. The decision to stop
granting these 5 systems of complementary medical care OKP reimbursement at the end of
the evaluation period after 2005 was not based on scientific facts but was at least in parts
politically motivated. After the referendum decision in favour of anchoring “the duty to
consider complementary medical care approaches” in the constitution, a new application for
automatic reimbursement is being submitted based on new data.
TCM is to be applied exclusively by specially trained and certified doctors (“certificate of
special ability in acupuncture and TCM”) if warranted by the indication, the resulting costs are
to be reimbursed by the OKP. Any indication covering the whole spectrum of medicine may
warrant TCM treatment if treatment by conventional medical practice is not absolutely
necessary. This explicitly excludes diseases which have been proven to respond most
efficiently to conventional treatment or where conventional medical treatment is needed to
prevent damage for the patient. For many diseases, Western medicine is not able to either
supply any treatment which is able to deal with the causes of the disease, or to supply any
treatment which leads to a satisfactory measure of healing or improvement in the patient’s
suffering. The symptomatic pharmacological treatment used by western medicine in this
context is often not well tolerated by the patient or leads to side effects with complications.
Many acute or chronically relapsing infections do not necessarily require an antibiotic
treatment. Considering the global threat of resistance, this is even to be avoided wherever
possible. Due to the different paradigm employed, TCM is often able to offer successful
treatment from its perspective for many diseases.
An update of the literature search shows that by now a great number of recent studies have
been published concerning treatment with TCM drugs. Overall, they appear to point towards
good effectiveness of TCM drug treatment compared to purely conventional treatment or to
placebo.
The safety of TCM drugs is guaranteed by the 4 certified companies in charge of distribution
in Switzerland. These companies are in possession of a provisional SWISSMEDIC license
and are responsible for ensuring that the distributed TCM drugs meet GPN-requirements, as
well as conforming to legal requirements concerning pesticide, heavy metal, bacterial and
other residues, as well as authenticating the contents of the individual drugs and drug
preparations.
Economic studies based on PEK and newer data show that treatment with TCM drugs is
cheaper than conventional medical treatment provided by a general practitioner. Prior
experience with the provisional reimbursement of the five complementary medical
approaches by the OKP in the past shows that this leads to costs shifting from the
supplementary health insurance (“Zusatzversicherung”) to the statutory health insurance. A
model constructed to estimate the cost-consequences (budget impact) of readmitting TCM to
reimbursement within the statutory health insurance shows a comparable development with
additional pointers towards savings on the part of the health care costs paid for by patients
themselves.
Overall, treatment with TCM drugs may be considered an effective and low cost treatment
approach given the appropriate indication which may in many cases present an addition or
an alternative to conventional medical treatment.
Liste der ersten identifizierten Publikationen (Reviews, Meta-Anylsen, klinische Studien)
Aus: Medline, Embase, Cochranre Reviews
(1) Adams D, Wu T, Yang X, Tai S, Vohra S. Traditional Chinese medicinal herbs for the
treatment of idiopathic chronic fatigue and chronic fatigue syndrome. Cochrane Database
Syst Rev 2009;(4):CD006348.
(2) Ahn A, Bennani T, Freeman R, Hamdy O, Kaptchuk T. Two styles of acupuncture for
treating painful diabetic neuropathy - A pilot randomised control trial. Acupunct Med
2007; 25(1-2):11-17.
(3) Allen J, Schnyer R, Chambers A, Hitt S, Moreno F, Manber R. Acupuncture for
depression: A randomized controlled trial. J Clin Psychiatry 2006; 67(11):1665-1673.
(4) Asher G, Coeytaux R, Chen W, Reilly A, Loh Y, Harper T. Acupuncture to initiate labor
(Acumoms 2): A randomized, sham-controlled clinical trial. J Matern Fetal Neonatal Med
2009; 22(10):843-848.
(5) Bian Z, X, Moher D, Dagenais S, Li Y, Liu L, Wu T, X et al. Improving the quality of
randomized controlled trials in Chinese herbal medicine, part II: Control group design. J
Chin Integr Med 2006; 4(2):130-136.
(6) Bian Z, X, Moher D, Li Y, Wu T, X, Dagenais S, Cheng C et al. Precise reporting of
traditional Chinese medicine interventions in randomized controlled trials. J Chin Integr
Med 2008; 6(7):661-667.
(7) Bian Z, Wu T, Liu L, Miao J, Wong H, Song L et al. Effectiveness of the Chinese herbal
formula TongXieYaoFang for irritable bowel syndrome: A systematic review. J Altern
Complement Med 2006; 12(4):401-407.
(8) Birks J, Grimley EJ. Ginkgo biloba for cognitive impairment and dementia. Cochrane
Database Syst Rev 2007;(2):CD003120.
(9) Blanke C, Naisabha G, Balema M, Mbaruku G, Heide L, M³ller M. Herba Artemisiae
annuae tea preparation compared to sulfadoxine- pyrimethamine in the treatment of
uncomplicated falciparum malaria in adults: A randomized double-blind clinical trial. Trop
Doct 2008; 38(2):113-116.
(10) Cai J, Wang H, Zhou S, Wu B, Song H, Xuan Z. Effect of Sijunzi decoction and enteral
nutrition on T-cell subsets and nutritional status in patients with gastric cancer after
operation: A randomized controlled trial. J Chin Integr Med 2008; 6(1):37-40.
(11) Cao H, Shang H, Ren M, Zhang J, Gao X, Xiang Y et al. Case recruitment in large-scale
clinical trials of traditional Chinese medicine. J Chin Integr Med 2007; 5(3):243-246.
(12) Cao W, Liu W, Wu T, Zhong D, Liu G. Dengzhanhua preparations for acute cerebral
infarction. Cochrane Database Syst Rev 2008;(4):CD005568.
(13) Cao Y, Pang J, Wang X, Shi Y, Shen W, Zheng Y, X et al. Current status of Chinese
herbal therapy for osteoarthritis. Chin J Clin Rehab 2006; 10(35):130-134.
(14) Chan C, Kuo M, Shen J, See L, Chang H, Huang J. Ding Chuan Tang, a Chinese herb
decoction, could improve airway hyper- responsiveness in stabilized asthmatic children:
A randomized, double- blind clinical trial. Pediatr Allergy Immunol 2006; 17(5):316-322.
(15) Chang TT, Huang CC, Hsu CH. Clinical evaluation of the Chinese herbal medicine
formula STA-1 in the treatment of allergic asthma. Phytother Res 2006; 20(5):342-347.
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Chuang Bing Du Xue Za Zhi 2008; 22(4):302-304.
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medicine) for heart failure. Cochrane Database Syst Rev 2007;(4):CD005052.
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China: a systematic review and meta-analysis. J Altern Complement Med 2006;
12(8):763-769.
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China: A systematic review and meta-analysis. J Altern Complement Med 2006;
12(8):763-769.
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medicine) for heart failure. Cochrane Database Syst Rev 2007;(4).
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resolving phlegm in treatment of systemic inflammatory response syndrome in acute
deterioration stage of chronic obstructive pulmonary disease: a randomized controlled
trial]. Zhong Xi Yi Jie He Xue Bao 2009; 7(2):105-109.
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resolving phlegm in treatment of systemic inflammatory response syndrome in acute
deterioration stage of chronic obstructive pulmonary disease: A randomized controlled
trial. J Chin Integr Med 2009; 7(2):105-109.
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functional constipation. WORLD JOURNAL OF GASTROENTEROLOGY 2009;
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(52) Gao WY, Lin YF, Chen SQ, Lu YP, Yang Z, Gong Y et al. [Effects of Changjishu soft
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(54) Gim G, Kim H, Kim J, Kim J, Whang W, Cho S. Antioxidant effect of tianwang buxin pills:
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(55) Goto H, Satoh N, Hayashi Y, Hikiami H, Nagata Y, Obi R et al. A Chinese Herbal
Medicine, Tokishakuyakusan, Reduces the Worsening of Impairments and Independence
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(57) Grant SJ, Bensoussan A, Chang D, Kiat H, Klupp NL, Liu JP et al. Chinese herbal
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(58) Guo HY, Cai Y, Yang XM, Wang ZH, Wang JL, Zhao XM et al. Randomized phase II trial
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a Chinese herbal medicine concoction for treatment of atopic dermatitis: a randomized,
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(70) Iwasaki K, Satoh-Nakagawa T, Maruyama M, Monma Y, Nemoto M, Tomita N et al. A
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Ganoderma lucidum (Lingzhi) and San Miao San supplementation in patients with
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blood-heat type psoriasis vulgaris: A randomized controlled trial. J Chin Integr Med 2008;
6(6):586-590.
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of Huannao Yicong capsule in senile patients with mild cognitive impairment. J Chin
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16
Auswertung Daten santésuisse Datenpool, TCM-Ärzte
Kennzahlen COM-Grundversorgerärzte
Bezeichnung
Anzahl Leistungserbringer
Durchschnittsalter Erkrankte
Anzahl Erkrankte
Anzahl Erkrankte pro Leistungserbringer
Kosten ohne Medikamente (direkt und veranlasst)
Kosten Medikamente (direkt und veranlasst)
Gesamtkosten (direkte und veranlasste Kosten)
Jahr 2000
4'842
45
4031918
832.70
Jahr 2001
4'898
45
4130767
843.36
Jahr 2002
4'944
46
4174318
844.32
Jahr 2003
5'021
46
4223129
841.09
Jahr 2004
5'056
47
4228398
836.31
Jahr 2005
5'067
47
4222493
833.33
Jahr 2006
5'048
47
4220702
836.11
Jahr 2007
5'061
48
4315266
852.65
Jahr 2008
5'087
48
4268068
839.01
1582654867 1661526517 1754563667 1769846597 1884840938 1904595909 1885326885 1929272064 1918459529
1654165864 1786808930 1871367812 1951907343 2103657256 2134464220 2105556233 2119556481 2135240857
3236820733 3448335451 3625931479 3721753939 3988498190 4039060126 3990883117 4048828545 4053700385
Durchschnittskosten ohne Medikamente pro Arzt
Durchschnittskosten Medikamente pro Arzt
Durchschnittskosten total pro Arzt
326860
341629
668488
339226
364804
704029
354887
378513
733400
352489
388749
741238
372793
416071
788864
375882
421248
797130
373480
417107
790587
381204
418802
800006
377130
419745
796874
Durchschnittskosten ohne Medikamente pro Erkrankte
Durchschnittskosten Medikamente pro Erkrankten
Durchschnittskosten total pro Erkrankten
392.53
410.27
802.80
402.23
432.56
834.79
420.32
448.31
868.63
419.08
462.19
881.28
445.76
497.51
943.26
451.06
505.50
956.56
446.69
498.86
945.55
447.08
491.18
938.26
449.49
500.28
949.77
Kennzahlen TCM-Ärzte
Bezeichnung
Anzahl Leistungserbringer
Anzahl Erkrankte
Jahr 2000
Jahr 2001
Jahr 2002
Jahr 2003
Jahr 2004
Jahr 2005
Jahr 2006
Jahr 2007
Jahr 2008
372
42
256773
690.25
390
42
266490
683.31
403
43
275624
683.93
419
43
284670
679.40
434
44
291606
671.90
444
44
293543
661.13
444
44
292285
658.30
447
45
304081
680.27
444
45
300158
676.03
116737889
70848965
187586854
126178632
76648434
202827066
134822317
81288118
216110434
136081025
84941878
221022903
147916056
93972535
241888591
147270078
94917599
242187677
144802250
95363447
240165697
152226413
96965844
249192258
151830497
99317115
251147612
Durchschnittskosten Medikamente pro Arzt
313812
190454
504266
323535
196534
520069
334547
201707
536254
324776
202725
527501
340820
216527
557347
331689
213778
545468
326131
214783
540914
340551
216926
557477
341961
223687
565648
Durchschnittskosten Medikamente pro Erkrankten
454.63
275.92
730.56
473.48
287.62
761.11
489.15
294.92
784.08
478.03
298.39
776.42
507.25
322.26
829.50
501.70
323.35
825.05
495.41
326.27
821.68
500.61
318.88
819.49
505.84
330.88
836.72
Kosten ohne Medikamente (direkt und veranlasst)
Kosten Medikamente (direkt und veranlasst)
Gesamtkosten (direkte und veranlasste Kosten)
Indizes Vergleich TCM-Ärzte mit COM-Grundversorgerärzten
Bezeichnung
Jahr 2000
Jahr 2001
Jahr 2002
Jahr 2003
Jahr 2004
Jahr 2005
Jahr 2006
Jahr 2007
Jahr 2008
0.93
0.83
0.94
0.81
0.94
0.81
0.94
0.81
0.94
0.80
0.94
0.79
0.94
0.79
0.93
0.80
0.93
0.81
Durchnittskosten Medikamente pro Arzt
0.96
0.56
0.75
0.95
0.54
0.74
0.94
0.53
0.73
0.92
0.52
0.71
0.91
0.52
0.71
0.88
0.51
0.68
0.87
0.51
0.68
0.89
0.52
0.70
0.91
0.53
0.71
Durchnittskosten Medikamente pro Erkrankten
1.16
0.67
0.91
1.18
0.66
0.91
1.16
0.66
0.90
1.14
0.65
0.88
1.14
0.65
0.88
1.11
0.64
0.86
1.11
0.65
0.87
1.12
0.65
0.87
1.13
0.66
0.88

ANTRAG Zusammenfassung und HTA-Literatur

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