IVIG reimbursement in Czech Republic Anna Sediva Institute of Immunology Prague, Czech Republic.

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Presentation transcript:

IVIG reimbursement in Czech Republic Anna Sediva Institute of Immunology Prague, Czech Republic

Czech Republic history of immunology in Czechoslovakia

Czech Immunology "Czech School of Immunology" founded by Milan Hašek, co-discoverer of the immunological tolerance phenomenon. Gregor Mendel genetics

Czech clinical immunology immunodeficiences Prof.Good in Czechoslovakia 1969 First book on immune deficiences 1979 „bubble boy“ 1980

two brothers with atypical form of XLA typical clinical symptomatology of XLA associated with deafness and mental retardation XLA - Bruton agammaglobulinemia case report history of Czech patients exon 19 deletion of BTK deletion of DDP X 22q ‚contiguous deletion syndrome‘ Dystonia Deafness Protein DDP Mohr-Tranebjaerg syndrome, mitochondrial disease

Diagnosis and therapy in time diagnosis made on clinical picture and laboratory investigation of humoral immunity substitution - plasma or IVIG czecho-slovak production first flow cytometer in Czechoslovakia missing B lymphocytes Allergic reactions, complications. Discontinued in 90´s.

Diagnosis and therapy in time 1993 XLA gene discovery 1995 deletion of exon Continuous deletion syndrome mitochondrial disease 2004 Patients in USA and Lithuania molecular diagnostics in Czech Republic ESID

Time, Czechoslovakia and IVIG 1957 IMUNA – plasma fractionation Šarišské Michalany

Time, Czechoslovakia and IVIG 1989 velvet revolution socialistic state directed health care system communism capitalism gradual development of health insurance Czech IVIG partly coveredEuropean IVIG partly covered

ESID and European cooperation IVIG sc immunoglobulins Diagnostic guidelines Therapeutic guidelines

Primary immunodeficiences Europe Czech RepublicInst. of Immunology 66% 18% 7% 6% 3% humoral cellular phagocytic complement other

IVIG current situation, Czech Republic immunodeficiences centers for ID excellent clinical effect reimbursement policies frequent changes uncertainity

IVIG current situation, Europe immunodeficiences hospital careout-patient care Czech Republiccoveredreimbursement based on fixed sum, problems with new patients Francecovered Germanycovered if > 24g/dosecovered Greececovered at the momentγ-globulin is not allowed for outpatient care, yet Hungarycovered Netherlandscoveredinsurance company has to approve beforehand, but mostly it is covered Polandcovered Spaincovered Swedencoveredpartly covered home care United Kingdomcovered

IVIG current situation, Czech Republic autoimmunity Kawasaki disease ITP others 1 g 4x10 18 molecules IgG reimbursed on an individual basis

IVIG current situation, Czech Republic problems money Low immunoglobulins, no infection? Near normal immunoglobulins with infections? Autoimmunity?

IVIG perspectives substitution based on therapeutic guidelines production of specific molecular targeted IVIG IVIG in autoimmune diseases IVIG in cancer molecular technologies in IVIG production IVIG production in plants mucosal immunoglobulins

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