Dag Andersson - CEO Diaverum, Chronic Diseases: The Everyday Epidemic


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Dag Andersson - CEO Diaverum Presentation at the
INSEAD Health Summit 2010 Paris, Chronic Diseases Panel,

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Dag Andersson - CEO Diaverum, Chronic Diseases: The Everyday Epidemic

  1. 1. Chronic Diseases – The Everyday Epidemic Dag Andersson CEO Diaverum Renal Services Group October 8, 2010 - Paris, France
  2. 2. Chronic diseases - what are they? <ul><li>Chronic diseases include diabetes, hypertension, hyperlipidemia, heart failure, depression, arthritis , and cancer , among others. </li></ul><ul><li>The most common chronic diseases in adults in USA are hypertension, hyperlipidemia, and diabetes. </li></ul><ul><li>Currently, 2/3 of all deaths in USA are attributable to one of five chronic disorders: cancer, chronic obstructive pulmonary disease, diabetes, heart disease, and stroke . </li></ul>October 8, 2010
  3. 3. Chronic diseases – the burden on society <ul><li>Data from 2005 show that: </li></ul><ul><li>- 44% of all Americans have at least one chronic condition . </li></ul><ul><li>- 13% have three or more . </li></ul><ul><li>By 2020, 157 million US citizens are predicted to have more than one chronic disorder , with 81 million having multiple conditions . </li></ul><ul><li>WHO believes 80% of chronic disorders could be eliminated by implementation of appropriate preventive measures . </li></ul>October 8, 2010
  4. 4. Chronic diseases – what is the cost? <ul><li>75% of health-care expenditure in USA is on chronic disease bills (US$ 1.7 trillion per year) and 76% of Medicare expenditure goes to beneficiaries with more than five chronic conditions. </li></ul><ul><li>Drugs are the costliest out of pocket outlay - people over 65 years with multiple chronic diseases spend on average approxmiately US$ 1300 a year on medicines. </li></ul><ul><li>Currently, less than 4 cents of every dollar spent on health care in USA goes on preventive and public-health measures. </li></ul>October 8, 2010
  5. 5. Ageing population and diabetes <ul><li>We are living longer . </li></ul><ul><ul><li> In the 20th century, 30 years gain in life expectancy achieved in OECD countries. </li></ul></ul><ul><ul><li> 75% of all born after year 2000 in OECD countries will become at least 75 years old . </li></ul></ul><ul><ul><li>… and 50% will celebrate their 100th birtday. </li></ul></ul><ul><li>Diabetes is an epidemic . </li></ul><ul><ul><li> In China today almost 250 million people suffer from diabetes or pre-diabetes . </li></ul></ul><ul><ul><li> In USA one in three children is predicted to develop diabetes, largely owing to obesity. </li></ul></ul><ul><ul><li> Estimated to presently affect 285 million adults , this number is expected to rise to 439 million by 2030 according to the International Diabetes Federation. </li></ul></ul>October 8, 2010
  6. 6. The importance of Diabetes <ul><li>The importance of diabetes is demonstrated by the fact that on December 20, 2006 the United Nations General Assembly passed a landmark resolution recognizing “that diabetes is a chronic, debilitating and costly disease associated with severe complications, which poses severe risks for families, Member States and the entire world………” </li></ul><ul><li>This is the first time a non-infectuous disease has been acknowledged as serious a global threat as the infectious epidemics. The resolution also ”decides to designate 14 November, the current World Diabetes Day , as a United Nations Day, to be observed every year beginning in 2007.” </li></ul>October 8, 2010
  7. 7. Chronic Kidney Disease (CKD) – some facts <ul><li>Diabetes is the leading cause of CKD globally. </li></ul><ul><li>In USA, 11.7% of the population suffer from CKD. </li></ul><ul><li>Overall, CKD contributed to 15% (nearly 1.2 million) of all hospitalisations in Australia , one million of which were for regular dialysis. </li></ul><ul><li>Major outcomes of CKD include progression to kidney failure , development of complications of impaired kidney function , and increased risk for cardiovascular disease . </li></ul>October 8, 2010
  8. 8. Prevalence of risk factors for CKD in US population October 8, 2010   Table 2. Prevalence of Risk Factors for Chronic Kidney Disease in US Population   Risk Factor Estimated Prevalence Estimated No. Diabetes mellitus Diagnosed 5.1 10.2 million Undiagnosed 2.7 5.4 million Hypertension 24.0 43.1 million Obesity 19.8 35.5 million Systemic lupus erythematosus 0.05 239,000 Functioning kidney graft 0.03 88,311 African American 12.3 34.7 million Hispanic or Latino (of any race) 12.5 35.3 million American Indian and Alaska Native 0.9 2.5 million Age 60-70 7.3 20.3 million Age ≥ 70 9.2 25.5 million Acute kidney injury 0.14 363,000 Daily NSAID use 5.2 13 million   Yearly NSAID use 30 75 million Note: Prevalence values expressed as percent of US population. Values for systemic lupus erythematosus, functioning kidney graft, acute kidney disease, and NSAID use are approximate. Abbreviation: NSAID, nonsteroidal anti-inflammatory drug. Source: American Journal Of Kidney Disease
  9. 9. End-stage renal disease due to diabetes October 8, 2010 Source: USRDS
  10. 10. CKD – some additional facts <ul><li>CKD is usually silent until its late stages, thus many patients with CKD are detected only shortly before the onset of symptomatic kidney failure. </li></ul><ul><li>In severe cases, kidney function may deteriorate to the extent that it is no longer sufficient to sustain life and, if untreated, will most likely cause death. This is called end-stage renal disease (ESRD) and patients with ESRD require renal replacement therapy (RRT) - either dialysis or kidney transplantation - to survive. </li></ul><ul><li>CKD can be detected with 2 simple tests : a urine test for the detection of proteinuria and a blood test to estimate the glomerular filtration rate (GFR). </li></ul>October 8, 2010
  11. 11. Prevalence of end-stage renal disease October 8, 2010
  12. 12. Some facts about CKD - examples from a study in Taiwan <ul><li>Prevalence of CKD in Taiwan was 11.9% , but only 3.5% of subjects were aware of their disorder. </li></ul><ul><li>Prevalence was substantially higher in subjects with low socioeconomic status compared with those with a high status (19.9% vs. 7.3%). </li></ul><ul><li>Subjects with CKD had a 83% higher mortality for all cause and 100% higher for cardiovascular diseases during a median follow-up of 7.5 years. </li></ul><ul><li>In the entire population, 10.3% of deaths were attributable to CKD , but 17.5% of deaths in the low socioeconomic status population. </li></ul>October 8, 2010
  13. 13. Some facts about ESRD <ul><li>In the year 2000 there were 400,000 ESRD patients treated with dialysis or transplantation in USA. </li></ul><ul><li>By year 2030 this number is expected to increase to more than 2 million people !! </li></ul><ul><li>In year 2010 the global ESRD population is estimated to exceed 3 million patients . </li></ul><ul><li>The cost for managing these patients will amount to approximately 1 trillion US$ . </li></ul>October 8, 2010
  14. 14. Cost implications of CKD/ESRD <ul><li>In USA, the annual Medicare cost for a CKD patient was $24,374 in 2007. </li></ul><ul><li>The per-patient year Medicare costs of ESRD amounted to $61,768 in 2007. </li></ul><ul><li>In 2006 the mean total dialysis-related cost per patient year was €54,777 in Germany. </li></ul><ul><li>For Medicare patients, CKD contributed to 27.6% of the cost whereas as CKD subjects constituted 9.8% of the population in 2007. </li></ul><ul><li>In USA 6.4% of total health care budget is allocated to ESRD patients (Japan 4.1% and South Korea 3.2%). </li></ul><ul><li> CKD is an enormous health care burden for the society! </li></ul>October 8, 2010
  15. 15. Screening and prevention of CKD <ul><li>There is insufficient evidence to support general population screening for CKD. </li></ul><ul><li>Diabetes, hypertension, and age 60 or greater are the primary CKD screening target conditions. </li></ul><ul><li>Preventive care of CKD patients with pharmacological and non-pharmacological approaches, i.e. secondary prevention . </li></ul><ul><ul><li>Probably cost-efficient ; modeling suggest large health care savings by slowing the progression of CKD by as little as 10%. </li></ul></ul><ul><li>Guest editorial in the May 2010 issue of Advances in Chronic Kidney Disease stating ”CKD: A Pandemic Calling for Concerted Public Health Action”. </li></ul><ul><li>… but the fact that people are getting older can not be avoided . </li></ul>October 8, 2010
  16. 16. Cost-efficient management of ESRD - what are the trends? <ul><li>Increased speed of privatisation . </li></ul><ul><ul><li>Large variability among countries. </li></ul></ul><ul><ul><ul><li>Private vs public. </li></ul></ul></ul><ul><ul><ul><li>Reimbursement rate & what is included. </li></ul></ul></ul><ul><ul><li>… but clear trend towards increased privatization. </li></ul></ul><ul><li>Wider scope of privatisation . </li></ul><ul><ul><li>Transplantation. </li></ul></ul><ul><ul><li>Outsourcing of whole renal department in hospitals, e.g. Poland & Sweden. </li></ul></ul>October 8, 2010
  17. 17. Type of dialysis providers (excluding non-profit) and market growth rates October 8, 2010 Source: Fresenius Medical Care Annual Report 2008; Diaverum market intelligence
  18. 18. Reimbursement per treatment in hemodialysis varies among countries October 8, 2010 EUR
  19. 19. Global renal services providers - what can they offer? <ul><li>Specialized in taking care of patients with renal diseases . </li></ul><ul><li>Development of best practices which are shared throughout the organization . </li></ul><ul><li>Ability to implement one culture with patient-focused agenda . </li></ul><ul><li>Standardized approach to education & training . </li></ul><ul><li>Strong focus on medical quality ; this is increasingly demanded by authorithies. </li></ul><ul><li>Large procurement volumes. </li></ul><ul><li> Delievery of cost-effient care but at the same time dedication to quality assurance & safety . </li></ul>October 8, 2010
  20. 20. Final words… <ul><li>” The high prevalence of chronic kidney disease and its associated all-cause mortality , especially in people with low socioeconomic status, make reduction of this disorder a public-health priority . Promotion of its recognition through the general public knowing their glomerular filtration rate and testing their urine is crucial to reduce premature deaths from all causes and to attenuate this global epidemic ”. </li></ul><ul><li>Source: Wen CP et al ., Lancet 2008; 371: 2173-82 </li></ul>October 8, 2010
  21. 21. Final words… <ul><li>Nestlé is challenging the global drugs industry with plans to invest SFr500m ($510m) over the next decade to support the creation of a standalone health science business to tackle obesity and chronic disease. The Swiss food group, which announced the move on Monday, appointed Luis Cantarell, one of its most experienced executives, to “pioneer a new industry between food and pharma” that will develop products to combat diabetes, heart problems and Alzheimer’s. </li></ul><ul><li>The decision reflects a trend among food and pharmaceutical groups that are converging around high-margin non-prescription health products, for both humans and animals. </li></ul><ul><li>“ The combination of health economics, changing demographics and advances in health science show that our existing healthcare systems . . . are not sustainable and need redesigning,” said Peter Brabeck, chairman, a key backer of the Swiss group’s push into nutrition. </li></ul><ul><li>Source: Financial Times September 27, 2010 </li></ul>October 8, 2010
  22. 22. Clinical and sociodemographic risk factors for CKD October 8, 2010   Table 1. Potential Risk Factors for Susceptibility to and Initiation of Chronic Kidney Disease   Clinical Factors Sociodemographic Factors Diabetes Older age Hypertension US ethnic minority status (African American, American Obesity Indian, Hispanic, Asian, or Pacific Islander) Autoimmune diseases Exposure to certain chemical and environmental conditions Systemic infections Low income/education Urinary tract infections Urinary stones Lower urinary tract obstruction Neoplasia Family history of chronic kidney disease Recovery from acute kidney injury Reduction in kidney mass Exposure to certain drugs   Low birth weight   Adapted with permission from National Kidney Foundation Clinical Practice Guidelines for CKD.5 Source: American Journal Of Kidney Desease
  23. 23. Criteria for the definition of CKD October 8, 2010   Table 4. Criteria for the Definition of Chronic Kidney Disease Structural or functional abnormalities of the kidneys for at least 3 months, as manifested by either: (1) Kidney damage, with or without decreased glomerular filtration rate (GFR), as defined by: ● pathologic abnormalities ● markers of kidney damage – urinary abnormalities (proteinuria) – blood abnormalities (renal tubular syndromes) – imaging abnormalities – kidney transplantation ● kidney transplant recipients   (2) GFR 60 mL/min/1.73 m2, with or without kidney damage Source: American Journal Of Kidney Disease