1. Jacek Rozniecki Dept. of Neurology Medical University in Lodz The Migraine management in Poland

2. Country description Demography – 38 mln Economy –GDP (Gross Domestic Product) – 1047 mld (bln) PLN = $385 mld (bln) –GDP/capita = $10 200 –HC expenditure – 7% GDP/capita = $744 % of population in „new” EC countries

3. Health care system Description of key Regulatory/Reimbursement assumptions –Free of charge (epilepsy*, PD, MG) –Lump (epilepsy**) (~$1) –30% reimbursement –50% reimbursement –Full charge Reimbursement/ triptans –Full charge, no reimbursement

4. The role of Headache Society, Centers and Specialists in migraine management Migraine Investigation Section of the Polish Neurological Society Polish Headache Society (in the structure of IHF) –National congresses of PHS –International conferences of PHS –Pharmaco-meetings Treatment – „old guidlines“, „new guidlines“ - in progress Education –Headache Academy (for neurologists) –School of Headache (for GPs) –Headache courses for neurological specialty –Booklets for headache patients –Polish Headache Association Headache centers –Lodz, Warsaw (3), Lublin, Poznan, Gdansk

5. The role of GPs in migraine management (supposed to be) Part in migraine treatment –First-line physician –Direct and fast contact –No need for diagnostics –No need for special conditions for routine patients care –No restrictions in terms of pharmaceuticals prescrptions Education –Courses, and cooperation with a neurologist Guidelines –The same as for neurologists

6. Headache care system - view of GP (The questionnaire prepared by Goril Bruvik Gravdahi from Norvegian National Headache Centre Department of Neurology and Clinical Neurophysiology Trondheim, Norway)

7. Headache care system - view of GP

10. „Current“ situation in migraine therapy Guidetti V., MSD Symposium, Barcelona 2001

11. The migraine awareness among population Specialist –Continuous education –Easy access to up to date clinical research data, publications, EBM guidlines –Participation in clinical and scientific meetings GPs –Continuous education –Possibility of quick consultation with a neurologist and/or headache specialist –Motivation of not sending a patient to a specialist Patients –Easy access to popular medical publications about common primary headaches –Access to simple self-evaluation/self-diagnostic tools –Patients‘ associations –Easy access to patients‘ internet forum –Enough of doctor‘s time for a patient –Patients‘ trust in their GP

12. The POSSIBILITIES how to IMPROVE it! Key activities: –Education, awareness and info for –Neurologists –GPs –Patients –Guidelines, EBM –Referal system for consultations with neurologists and headache specialists –Internet forum and consultations –National headache journal widely open for neurologists as well GPs International cooperation –Guidelines –Meetings –International headache journals subscrptions Free market mechanisms for triptans

13. The POSSIBILITIES how to IMPROVE it! Maxalt (rizatriptan) - $ 13/ tab = Euro 9/ tab Zomig (zolmitriptan) - $ 12/ tab = Euro 8,7/ tab Relpax (eletriptan) - $ 7,5/ tab = Euro 5,2/ tab Imigran (sumatriptan) – $ 6,5/ tab = Euro 4,7/ tab Sumamigren (sumatriptan) - $ 5,9/ tab = Euro 4,2/ tab Sumigra (sumatriptan) – $ 5,2/ tab = Euro 3,9/ tab Cinie (sumatriptan) - $ 3,3/ tab = Euro 2,4/ tab............................... - $ 1,4/ tab = Euro 1/ tab or reimbursements (realistically – no chance!)