1. The Value Of In-vitro Diagnostics Healthcare challenges in the 21 st century for governments & hospitals & how in-vitro diagnostics can contribute to overcoming these Regina Kloss-Wolf Director Global Strategic Health Initiatives, Abbott Laboratories Forum “For Healthy Life” December 9-10, 2013, Moscow

2. The Healthcare World In The 21 st Century: Having To Do More With Less 2 Economic Reality: Decreased healthcare budget Healthcare Reality: Increased healthcare demand Challenge #1 Ageing population Challenge #2 Rise of NCDs Demographic change reinforces rise of NCDs Healthcare reality: increased demand for healthcare

3. Healthcare Reality - Challenge 1: Population Ageing 3 Sources: United Nations, Population Facts, Population Ageing and the non-communicable diseases, April 2012, accessed 25 November 2013.Population Ageing and the non-communicable diseases United Nations, World Population Ageing 1950-2050, accessed 25 November 2013.World Population Ageing 1950-2050 http://www.un.org/esa/population/publications/worldageing19502050/pdf/173russi.pdf 60+yrs 2000: 18% 2050: 37% 2025 : 26% Russia

4. Healthcare Reality - Challenge 2: Non Communicable Diseases - Key Facts 4 “Non Communicable diseases (chronic diseases) are not passed from person to person. They are of long duration & generally slow progression” NCDs cause more than 36 million deaths worldwide – 63% of all mortality Between 70% & 80% of Europe’s healthcare costs are spent on chronic care, amounting to €700bn Early intervention may enable early detection & hence contribute to cost-reduction Sources: WHO, factsheet on Chronic Diseases, accessed 25 November 2013. WHO, factsheet on Noncommunicable diseases, accessed 25 November 2013.Chronic DiseasesNoncommunicable diseases EPHA, Extend healthy years by tackling chronic diseases in a life-course approach, accessed 25 November 2013.Extend healthy years by tackling chronic diseases in a life-course approach

5. Healthcare Reality - Challenge 2 Rise Of Cardio Vascular Diseases & Associated Costs 5 200820102030 Sources; AIHW, Why are mortality data important?, accessed 25 November 2013.Why are mortality data important? World Economic Forum, Non-communicable Diseases to cost $47 trillion by 2030, New Study Released Today, accessed 25 November 2013.Non-communicable Diseases to cost $47 trillion by 2030, New Study Released Today World Heart Federation, The cost of CVD, accessed 25 November 2013.The cost of CVD WHO, factsheet on Cardiovascular Diseases,, accessed 25 November 2013.Cardiovascular Diseases,, 200820102030 CVDS 17.3 million people dying of CVDs Cost of CVDs: $863bn CVDs 23.3 million of people dying of CVDs Cost of CVDs:$1,044bn

6. Healthcare Reality - Challenge 2 Rise Of Cardio Vascular Diseases & Associated Costs 6 2012 NCDs account for 90% of all deaths CVDs account for 57% of all deaths Russia 2006-2009 NCDs Cost of CVDs: 3% of GDP RUR CVDs Source: Petrukhin IS, Lunina EY. Cardiovascular disease risk factors and mortality in Russia: challenges and barriers. Public Health Reviews. 2012;33:436-49

7. So What Does The Rise Of NCDs Mean? 7 The worldwide rise of chronic Non Communicable Diseases: a slow-motion catastrophe Margaret Chan WHO Director General

8. 8 Increasing use of Clinical Guidelines and Quality Measurements Globally Clinical outcomes Cost- effectiveness Mortality rates Hospital bed occupancy rate Cost per discharge Length of stay Unplanned readmission Average waiting time for patient How Do IVDs Fit Into This ?

9. 9 IVD Case Studies How can IVDs contribute to overcoming this challenge?

10. The Diagnostics Paradox: Recognised Important Role, but Low Investment 10 Early diagnosis & treatment stops NCDs progressing into costly, crippling complications & premature death NCD Alliance 10 Medical decisions are based on IVDs 70% Healthcare budget spent on IVD’s 2% Sources: NCD Alliance, Discussion Paper No. 3 Geneva 2011, accessed 25 November 2013.Discussion Paper No. 3 EDMA answer to the European Commission consultation on Community Action on Health Services, 31 January 2007, p.2answer

11. IVDs: One Of The Key Tools In Diagnostics 11 Monitoring of prescribed treatments Disease prevention& Population screening Assessment of medical interventions Diagnosis, treatment selection & Prognosis In Vitro Diagnostics are used alongside the healthcare pathway

12. Case1: Early diagnosis of heart failure and differentiation from other diseases causing dyspnoea The challenge The challenge Management of patients with acute Dyspnoea The impact on quality measurements Biomarker helps to diagnose congestive heart failure BNP (B-type Natriuretic Peptide) Cost per discharge HF is the most frequent diagnosis associated with 30 day readmission 30 Treatment cost Mortality Cost per patient $-1.854 Admission rate -10% Length of stay -2.2 12

13. Case 2: Taking The Right Decision In Case Of Heart Attack In Patients With Acute Chest Pain The challenge Correct triaging The impact on quality measurements Earlier triage of patients, already after 2-4 hrs. with hs Troponin vs. 6-12 hrs. hs Troponin Cost per discharge Only 7-20% of patients who present with chest pain in the ED are confirmed for diagnosis of myocardial infarct 7-20% More confident rule out for up to 40 % with suspected acute coronary syndrome 40% Waiting times Cost per discharge Better allocation 13

14. Conclusion 14 The burden of the ageing world population and NCDs will continue to rise. IVDs play an important role in optimizing care and minimizing cost IVDs are critical to the successful implementation of clinical guidelines and quality measures.