Player is loading...
Romosozumab limitation (CH): challenges and opportunities
Pr. Dr. S. Ferrari, Geneva
Friday, May 13, 2022 · 12:25 p.m. · 15m 03s
Embed
Embed code is not allowed
This talk is part of a Private webcast, embeding is not permited.Transcriptions
Note: this content has been automatically generated.
00:00:00
my role is to exactly uh discuss wheeze
00:00:03
you up the the condition for reimbursement and the
00:00:08
the chances and opportunities that come uh with act uh that is just remind you first that um
00:00:15
yeah uh that the um the the main problem uh it is not to have a
00:00:21
drones we can prescribe the main problem is to identify the patients who need the drugs
00:00:26
uh this is from the the scope a european a publication where susan
00:00:32
is included just remind you that so far we have only about them
00:00:37
ten percent or less of a hospital to do trauma or
00:00:40
to be trauma surgery and therefore we see patients with a
00:00:44
freshly fractures that actually have a fracture is all service and
00:00:48
so we're missing a a huge opportunity to uh to to
00:00:51
what do i say that because the first think uh that you will see in in the new tattoos will can prescribe
00:00:58
two logical e. as water apartheid before especially sing about religion the chronology can prescribe
00:01:04
uh we also a full room will now
00:01:07
have a doctor's medical centres with expertise in osteoporosis
00:01:12
whatever it definition is i think it gives good opportunities but what really really pleases me
00:01:19
is that we convince the bay aggie to say that uh off towards will have fractured is all services
00:01:26
can't prescribe wrong uh independent of your qualification as a doctor uh you can be a directory shown you
00:01:32
can you know to pick surgeon whatever how is having an official f. l. s. can prescribe so it is
00:01:39
important that we keep developing uh for less is because it well for any file patients uh at very high
00:01:45
risk of course but the reason fractures and we and we have more opportunities then to give them these drug
00:01:51
uh i remind you that the structure of anaphora lesser require some sort of
00:01:54
a coordinator because the fright maintain the type of cable so project fractures beat
00:02:00
a nurse a a case manager uh all or even
00:02:04
industry and you should assistant whatever the will bring eventually
00:02:08
uh the pieces of the pause all of the fracture patient to cater to eventually
00:02:12
orient the patient to a a a bone specialist would take your just browse part
00:02:17
and that the goal is one five eighty percent of the patients with scratches at least uh you know whom a
00:02:23
half at least recommend for therapy and and eighty percent of
00:02:26
that half a should have a a twelve months a compliance
00:02:31
that is the overall rule um uh and and goal of an f. s. of course is challenging
00:02:38
um this is just the the the genie the model uh even knows what we don't
00:02:42
capture more than fifty percent of all fractures in the whole store because some of them
00:02:46
a three conservative be for example are really is the home of very quickly a very hard put a hand on them
00:02:52
and then you have to have automated systems eventually get tax uh a prevalent vertebral fractures on x. rays and stuff like that
00:02:58
so i know it's very demanding but the idea is not to
00:03:01
make it all at once of course is to start small and grow
00:03:05
uh and that there there are several opportunities uh
00:03:08
therefore to grow a fractured is also this is
00:03:12
a starting perhaps a a ways of improving case detection you start with the obvious ones you'll need fractures
00:03:18
uh then me you you may start to include the red logical but your fractures and then move
00:03:23
to the to the all the non heap convert consider to be treated the harder to grasp
00:03:28
um there are facilitating a uh tools like the watch your body or
00:03:33
your wife as you know the best practised framework questionnaire works now online
00:03:37
and allows you to be evaluated for the quality of your service uh there
00:03:41
is key performance indicators to allow you to monitor the performance of your service
00:03:47
something that will soon implementing all suisse uh have less network and and the our software is in development
00:03:53
uh in currently being tested in in a couple of countries and starting soon to be tested in geneva
00:03:58
that would allow us up to use these uh informatics go
00:04:01
tools to work capture uh the performance of l. f. s.
00:04:05
ah to improve appearance with therapy which is important for the long term monitoring of what we do a
00:04:11
pools of telling maybe seen that we've learned to use during the call with a times uh maybe also useful
00:04:17
uh and abilities can created being developed to convince the authorities uh as
00:04:22
as the the canadian said that you showed intake uh that is worse wow
00:04:26
uh twenty fine treat patients was enough i so um i think that the
00:04:30
fact that that that they are gay about normal set for the first time
00:04:34
f. i. s. e. is a a a a as a put down a possibility to prescribe these drug
00:04:41
despite the fact this is the most expensive drug on the market really opens up and uh the
00:04:47
the the necessity to continue to improve and developer i fallacies what of course it's like you is doing
00:04:53
i was all sponsored as this we separate as a network of that would be a a noted
00:04:58
meaning at the end of the year about that so we don't have one contact us will help
00:05:04
okay so the most what i think is the patient profile um you
00:05:08
us only familiar with this now this is the tree conditions that allow reimbursement
00:05:13
so here is the patients that even increase because of the history of the recent major all sprouting fracture
00:05:19
note that by a major sporting fractured the excluded the radius
00:05:24
but they keep the or the major ones paucity school below
00:05:27
ministry point far that's panel heap quite restrictive i'll come to that
00:05:32
second possibilities are very high risk of fracture according to franks and the
00:05:37
um uh s. peggy o. uh a recent guidelines which or show also
00:05:42
and the last possible condition for treatment is uh at least two major
00:05:46
all sporting fractures this time including the reduce at any time in the past
00:05:52
now when you look at this uh depending on your optimism or pessimism gonna say is the glass half full half empty
00:05:59
i especially like this one
00:06:03
and i would like to do with you the reality check okay so i'm a base a
00:06:07
is a or the patients we have with
00:06:10
osteoporosis remind in switzerland estimation are eight hundred thousand
00:06:16
these are the ones we severe osteoporosis at high risk of fracture
00:06:21
and weaving that now we had these reimbursements subgroups defined by the meat that's you
00:06:27
and i would like to show you how uh we can do
00:06:31
to improve uh defeating to those conditions when we examine uh operations
00:06:37
and and our start by in fact the easiest which is
00:06:41
the very high risk group that is a a potential reimbursement forum
00:06:48
so reminder that we have defined a very high risk group as
00:06:52
a fax can your part b. d. of a major all supported fracture
00:06:57
that lies a ball of the usual intervention
00:07:00
threshold in fact that lies twenty percent above so
00:07:06
up parts will be t. above thirty percent at age fifty
00:07:11
and above fifty percent at age seventy would qualify for all you can tell me this
00:07:18
is crazy this is such a high risk of fracture that those base and don't exist
00:07:23
uh but they do uh and and n. l. guidelines as you know when
00:07:27
you are in these very high risk group like to be even increased group
00:07:31
we for the stratified but that type of fracture that you
00:07:34
have and again if you have a type of nature's body fracture
00:07:39
a rumble become supposed to be so as i said you got
00:07:42
if a it's crazy navigate these probabilities in fact is quite simple
00:07:47
this is the women of fifty five how to restructure at fifty one
00:07:52
smokes the mortar as any sort of the fracture or t.
00:07:56
score the hippies minus two point seven so not re below
00:08:01
frocks switzerland tells you thirty four percent most part b.
00:08:05
t. at ten years she falls in the category for all
00:08:10
second case scenario seventy years old are vertebral fractures
00:08:14
supported uh on a lateral chest x. ray for uh
00:08:20
three mon yeah uh she's on fridays on five because of some purity carrier he'd get the might of three point one
00:08:27
fax forty six percent at that age she is in the very high risk category
00:08:32
so by by by by doing for arts and by entering the right
00:08:37
uh data uh we can have a lighting quite a number of patients
00:08:42
who do not have t. scores below minus three point
00:08:45
five as defined in the first reimbursement but yeah yeah
00:08:49
but who things to the accumulation of risk factors will still be connected to i
00:08:55
the next question is okay what i'm gonna try to optimise my
00:09:00
uh pause fracture care and use roam all in patients was reason fractures
00:09:05
uh so if i do that for example through a freshly
00:09:08
is all service uh uh uh where do those patients feet
00:09:14
so can we prescribe promo impatience at imminent risk and of course yes we can so i'm gonna show some data
00:09:21
that i've been uh uh allies by tuition valet any company
00:09:25
enough from all peers what is a retrospective study of that
00:09:29
team hundred thirty eight subjects with a hip fracture i did you use the hospital between the two
00:09:35
thousand thirteen eighteen with a minimum of two years follow up a sec above half i've been uh uh
00:09:43
taken care of by by d. f. s. program at in those days were doing much better now course
00:09:49
and the main question we asked your is what is the
00:09:51
re fracture rate and what are the baseline characteristics of those patients
00:09:57
to see how they could feed into the room reimbursement criteria in particular
00:10:02
depending on on on the various criteria so those are eighty three years old
00:10:08
a thirty five percent of the previous fracture uh the actually nobody
00:10:12
other therapy at them of the hip fracture you all know that so
00:10:17
what proportion of hip fracture patients come to a hospital which
00:10:21
feet in the wrong all prescription based on tracks very high risk
00:10:29
so the average for our singles patients before the fracture
00:10:33
is thirty three percent after he fractured you forty one percent
00:10:37
um so it means that that hobby afar off all those
00:10:42
hip fracture patients are about fifty percent in terms of racks
00:10:47
and so feeding the very high risk category so just like that get got very high risk if
00:10:52
you do things where you already gonna capture quite a bit now note that this is before dexter
00:10:59
when you do the bags are and we calculate the facts the part before like ten percent
00:11:04
so it would be less likely to have grown reimbursement in those patients after
00:11:09
they're done before the decks so should we be miserable you better do the request
00:11:14
to the insurance ways the for x. before you send them to the decks just a sec
00:11:19
now don't forget this art for art's does not
00:11:23
take into account the reason see all the fracture when
00:11:26
you create previous fractured because you just had a he pork bellies it doesn't tell the fries that it's reset
00:11:32
and whatever reason fracture in fact your portability of uh
00:11:36
for a future fracture increases further and our tools being developed
00:11:41
why joyous facts probabilities by the reasons you're the fracture if they uh from iceland board
00:11:48
where you see that at least in those parts proposal women here
00:11:52
if you have a reason fracture rather than an order fracture you
00:11:57
can walk deprive hotspot b. t. by fifty percent to three four so
00:12:02
we are all we will develop this for switzerland as well
00:12:06
so when you get your patient ways a recent fracture she doesn't fit
00:12:10
into any other category and you would do it by france very high risk
00:12:15
using the marquis prior by the results of the fracture would give us more patients suitable forum of their
00:12:22
the second condition reimburse these models batik fractures that's the easy one right
00:12:27
as i said before from t. i. study if you just looking women with
00:12:30
uh recently fracture and you take their history already as far as the previous fracture
00:12:36
in addition to that it is highly recommended
00:12:42
to use the t. or fracture assessment v. a. fe as part of the
00:12:47
day exact assessment in those patients because on the v. f. a. you will spot
00:12:52
uh last fall portion of your patients who already have
00:12:55
a predator that your fracture why because the increasing incidence
00:12:59
of the table fracture these ten years before he fracture
00:13:03
and so your single the fracture now becomes multiple fractures
00:13:08
and things so that you can prescribe from what you want
00:13:12
not the last and most difficult category of course as as the result more off with the t. score bloomer
00:13:17
three point five because we all know all that either
00:13:21
the patient easy fractures about fifty percent hobble still being yeah
00:13:27
and saw the proportion of patients what it is called global three point five
00:13:31
i'm on operation busy fractures is only seventeen percent so it's probably
00:13:36
not going to be the category that brings you to malls will prescriptions
00:13:41
seen the fractional is also this context but of course you all
00:13:45
the patients context i showed it to case of of bank they
00:13:48
uh this is gonna be a a large indication for a role motor so again uh we have i think
00:13:56
great opportunities if we think of all the possible conditions
00:14:02
for reimbursement together and there are ways to optimise that
00:14:07
um first of all through development of f. l. s. twelve or twenty five
00:14:12
those patients out at the at the at the highest reese because the reason fracture
00:14:17
and remember that it's not just about the one condition but i
00:14:21
if you integrate for x. perhaps adjusting for reasons of the fracture
00:14:27
that begs always the v. a. fe to detect the privilege of people fractured which they become old people
00:14:34
uh n. taking altogether we we may i think really maximise
00:14:39
uh the number of patients who may be suitable for all
00:14:43
kind of course you have to discount the cardiovascular risk in those days previous a mile stroke
00:14:47
uh but still uh it's likely that is going to come uh
00:14:51
an important wrote for for large number of these very high risk patients
Conference Program
Introduction
Pr. Dr. S. Ferrari, Geneva
May 13, 2022 · 11:45 a.m.
Romosozumab clinical data
Pr. Dr. B. Langdahl, Aarhus, DK
May 13, 2022 · 11:50 a.m.
118 views
Romosozumab limitation (CH): challenges and opportunities
Pr. Dr. S. Ferrari, Geneva
May 13, 2022 · 12:25 p.m.
Questions & Answers Session
May 13, 2022 · 12:40 p.m.
Short- or long-term denosumab therapy? Part 1
Dr. J. Everts-Graber, Bern
May 13, 2022 · 1:37 p.m.
401 views
Short- or long-term denosumab therapy? Part 2
Pr. Dr. S. Ferrari, Geneva
May 13, 2022 · 1:52 p.m.
Clinical debate: Short- or long-term denosumab therapy?
May 13, 2022 · 2:02 p.m.
113 views
