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Hong Kong - Current Situation in Control Strategies and Health Systems in Asia
- 1. 1st Pan-Asian Conference on Haemoglobinopathies Current situation in controll strategies and H lth Systems in A i C t it ti i t t t i d Health S t i Asia Hong Kong - China Vincent Lee Department of Paediatrics ⾹港中⽂⼤學 Prince of Wales Hospital The Chinese University of Hong Kong The Chinese University of Hong Kong
- 3. Demographic Data The Special Administrative Region of China Landmass 1,100 km2 Population 7 million Ethnics 95% native Chinese Most being Southern Chinese Annual Birth Rate 11.4 per 1000 population 88,000 live births in 2010 M di Median I Income USD 18,000 per annum 18 000 Health Budget USD 4.8 billion in 2010 16.1% 16 1% of recurrent expenditure Census Report 2011 HK Government
- 4. Health System - Public Operated by Hospital Authority Op y p y Statutory body accountable to the Government 41 public hospitals – 27,000 beds, 1.4 million discharges 48 specialty clinics – 8 7 million attendances i lt li i 8.7 illi tt d 74 General out-patient clinics – 5.2 million attendances Charges Acute Hospital Stay US$6.4 admission, US$12.8 per day SSpecialist Clinic Vi it i li t Cli i Visits US$7.7 US$7 7 per visit i it General Clinic Visits US$5.8 per visit Medications US$1.3 per item per 3 months Waived for hospital discharges
- 5. Health System - Private 12 Registered private hospitals All charges paid by patients / f h id b ti t families ili Non mandatory medical / health insurance y All thalassaemia major patients are being taken care in public hospitals
- 6. Epidemiology for Thalassaemia Carrier rates: C α- thalassaemia 5.0% (--SEA) Deletion 4.5% β- thalassaemia 3.1% Deletion of CTTT at codon 41-42 1.2% C T at postision 654 in IVS2 1.0% A G at nucleotide -28 0.4% A T at codon 17 t d 0.2% 0 2% G T at codon 43 0.1% Haemoglobin E 0.3% Lau YL, Chan LC, Chan YYA et al. N Engl J Med 1997
- 7. Epidemiology for Thalassaemia Estimated number of affected pregnancies p g α- thalassaemia 145 per year β- thalassaemia 80 per year Actual number of new cases about 3 per year Missed prenatal diagnosis p g Declined prenatal diagnosis Antenatal check-up done outside Hong Kong WWrong prenatall di t diagnosis results i lt
- 8. Diagnostic Services Pre-marital / Pre-pregnancy blood test and counselling p g y g Family Planning Association P Prenatall di t diagnosis i Available in both private and public hospitals Universal screening of pregnant women g p g If MCV <80fL; paternal screening of MCV Maternal and Paternal Hb pattern and iron profile CCounselling lli CVS or amniocentesis if mutation is found
- 9. 363 Thalassaemia Major Patients Au WY, Lee V, Lau CW et al. HK Med J 2011
- 10. Blood Transfusions All thal major p j patients are being taken care in p g public hospitals p All transfusions are free-of-charge R Regular 3 t 5 weeks blood t l to k bl d transfusion f i Targeted pre-transfusion Hb ≥9.5g/dL All blood and blood components are supplied by Hong Kong Red Cross Blood Transfusion Service V l t Voluntary, non-remunerated blood d t d bl d donation programme ti
- 11. Iron Chelation All three iron chelators are available and registered g Deferioxamine is given free-of-charge to all patients Deferiprone is given free-of-charge to all patients who fail to achieve adequate iron chelation (esp cardiac) with deferioxamine Deferasirox is given free-of-charge since April 2011 To patients up to six years old To patients who cannot tolerate the toxicities of deferioxamine and / or deferiprone To patients who fail to achieve a good chelation despite good compliance
- 12. Iron Chelation All patients are receiving iron chelation therapy p g py About 50% are on combined deferioxamine and deferiprone All patients below 6 years are on deferasirox Deferasirox may also be given to other patients as self-financed medication Iron status assessed by Serial serum ferritin (2 to 3 times a year) S i l MRI T2* (once every 1 to 2 years) since 2006 Serial ( t ) i
- 13. Multidisciplinary Team Close relationships with cardiologists and endocrinologists C p g g Close relationships with patient and parent support group Child Children’s Thalassaemia Foundation ’ Th l i F d ti The Thalassaemia Association of Hong Kong
- 14. Deaths Au WY, Lee V, Lau CW et al. HK Med J 2011
- 15. Our Future Transition of adult patients from p p paediatric units to adult units Redistribution of resources Adjustment of patients’ expectations and self-care role Establishment of reference centres: One paediatric centre will be up in 2016 with the opening p p p g of the first children’s hospital in Hong Kong One for the adult?