MENTAL HEALTH CARE MENTAL HEALTH CARE

REFORM IN LITHUANIA: REFORM IN LITHUANIA:

THE MAIN TRENDS AND FINANCINGTHE MAIN TRENDS AND FINANCING

Ona DavidonienėState Mental Health Centre

MENTAL DISORDERS IN LITHUANIA (per 100 000)

2408,6

2287,5

2170,12116,6

2639,5

2090,8

2000

2100

2200

2300

2400

2500

2600

2700

1996 1997 1998 1999 2000 2001

Psychiatric disorders

4645,5

4288,9

4210,94175,14194,2

4217,8

1996 1997 1998 1999 2000 2001

Total number of mentaldisorders

Data of State Mental Health Centre of Lithuania

SUICIDES IN LITHUANIA 1930-1940 AND 1986-2001

(per 100 000)

44,1

77,2

15,0

0

10

20

30

40

50

60

70

80

90

19

30

19

31

19

32

19

33

19

34

19

35

19

36

19

37

19

38

19

39

19

40

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

Su

icid

es

pe

r 1

00

00

0 p

op

ula

tio

n Male

Female

Total

SUICIDES IN URBAN AND RURAL AREAS IN LITHUANIA 1930-1940 AND 1980-2001

(per 100 000)

34,8

62,8

0

10

20

30

40

50

60

70

1930

1932

1934

1936

1938

1940

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

Su

icid

es p

er 1

00 0

00 p

op

ula

tion Rural area

Urban area

GROWTH OF DRUG ADDICTION MORBIDITY IN LITHUANIA

(per 100 000)

Data of State Mental Health Centre of Lithuania

117,2

95,383,377,577,4

63,4

34,026,1

0

40

80

120

160

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

Mo

rbid

ity

pe

r 1

00

00

0 p

op

ula

tio

n

Drug and toxic substances addicts

MENTAL HEALTH CARE REFORM

Pre-reform state

In-patient treatment

Outpatienttreatment

Reform

Reform target

In-patient treatment

Outpatienttreatment

MENTAL HEALTH ACTS AND PROGRAMMES

1.Mental Health Care Act (1995) (http://www.vpsc.lt).

(Amendments made in 2001).

2.Narcotic and Psychotropic Substances Control Act

(1998) (http://www.vpsc.lt).

3.State Programme on Mental Disease Prevention

(1999) (http://www.vpsc.lt).

4.National Drug Control and Drug Use Prevention

Programme (approved in 1999).

5.State Alcohol Control Programme (approved in 1999).

MENTAL HEALTH CENTRES STAFF IN LITHUANIA

MENTAL HEALTH CENTRES

1 January, 1999

1 January, 2000

1 January, 2001

1 January, 2002

49 55 59 61

Specialists for mental health

Psychiatrists 102,25 105,5 117,25 123,0Child psychiatrists 26,25 36,0 39,0 40,36Nurses 125,75 147,5 156,25 165,15Social workers 14,5 65,25 98,0 108,5Psychologists 3,0 26,5 57,25 66,6

Specialists for addictions

Psychiatrists 36,75 30,5 34,75 34,25Nurses 22,25 44,5 39,75 40,85Social workers 6,5 20,5 23,0 25,8Psychologists 2,5 7,0 10,25 12,35

Data of State Mental Health Centre of Lithuania

PRESCRIPTION COVERAGE OF PSYCHOTROPICS IN LITHUANIA

Schizophrenia,

schizoaffective disorders

(F20; F25)

AmisulprideClozapineOlanzapineRisperidone

100 % coverage

FlupentixolFluphenazineHaloperidolTrifluoperazineZuclopenthixolLithiumTrihexyphenidylum

80 % coverageSchizotypal and

delusional disorders

(F21 - F29)

Amisulpride

Olanzapine

Risperidone

Haloperidol Fluphenazine Trifluoperazine Zuclopenthixol Flupentixol Citalopran Fluvoxamine Lithium

Amitriptyline Paroxetine TrihexyphenidylumFluoxetine Sertraline

Moderate and severe

affective disorders

(F30.2; F31.1-F31.5;

F32.1-F32.3; F33.1-F33.3)

Citalopran Fluvoxamine FluoxetineAmitriptyline Paroxetine SertralineHaloperidol Trifluoperazine Lithium Mirtazapine Reboxetine Trihexyphenidylum

Dementia

(F00 (G30); F01-F03)

Amitriptyline Donepezil MelperoneHaloperidol Trifluoperazine Lithium Memantine Tiapridal Trihexyphenidylum

50 % coverage

Organic psychotic disorders

(F06)

Citalopram FluoxetineFluphenazineFluvoxamineHaloperidolMirtazapineParoxetineTrifluoperazineSertralineLithiumTrihexyphenidylum

EUROPE (NORTH AND SOUTH) – N5A ANTIPSYCHOTIC MARKET

333.9

1206.0

0

200

400

600

800

1000

1200

1400

Q1/97

Q2/97

Q3/97

Q4/97

Q1/98

Q2/98

Q3/98

Q4/98

Q1/99

Q2/99

Q3/99

Q4/99

Q1/00

Q2/00

Q3/00

Q4/00

Q1/01

Q2/01

Q3/01

Q4/01

Q1/02

Sa

les

$ M

N5A9 Conventionals

N5A1 Atypicals

Source : IMS Health WinEI Q1/02 (Actual Exchange Rates)Countries and Panels included :- UK; HOLLAND; SWEDEN; POLAND; DENMARK; IRELAND; CZECH REP; GERMANY; FRANCE; SPAIN; ITALY; SWITZERLAND; AUSTRIA; GREECE; PORTUGAL; BELGIUM

NORTH AMERICA – N5A ANTIPSYCHOTIC MARKET

172

5548

0

1000

2000

3000

4000

5000

6000

Q1/97

Q2/97

Q3/97

Q4/97

Q1/98

Q2/98

Q3/98

Q4/98

Q1/99

Q2/99

Q3/99

Q4/99

Q1/00

Q2/00

Q3/00

Q4/00

Q1/01

Q2/01

Q3/01

Q4/01

Q1/02

Sa

les

$ M

N5A9 Conventionals

N5A1 Atypicals

Source : IMS Health WinEI Q1/02 (Actual Exchange Rates)Countries and Panels included :- USA; CANADA

LITHUANIA – N5A ANTIPSYCHOTIC MARKET

0,357

7,374

0,0

2,0

4,0

6,0

8,0

Sal

es L

T M

N5A9 ConventionalsN5A1 Atypical

ATYPICAL ANTIPSYCHOTICS PRESCRIPTION GROWTH OVER TIME

0

5000

10000

15000

20000

25000

Nu

mb

er

of

Rx

(0

00

s)

Others

Perospirone

Amisulpride

Ziprasidone

Clozapine

Risperidone

Seroquel

Olanzapine

*Market Definition = N5A1 Atypical Antipsychotics

Markets = USA, UK, Canada, Netherlands, Germany, Italy, Japan

Source : IMS Health MIDAS Dataview MAT Q1 2002

PRESCRIPTION MARKET SHARE VS. MAIN COMPETITORS

39,1

32,0

26,5

21,5

48,8

38,7

69,7

4,9

11,9

6,4

43,6

4,3

32,0

4,8

35,8

18,2

9,9

6,5 5,6

16,6

6,6

46,6

35

40,7

23,3

6

17,6

10,89,7

4,5 6,57,9

7,6

0

10

20

30

40

50

60

70

80

USAUK

Lithuan

ia

Ger

man

y

Canada

Italy

Japan

% R

x M

arke

t S

har

e

Olanzapine SeroquelRisperidone ClozapineZiprasidone AmisulpridePerospirone Others

Source : IMS Health MIDAS Dataview MAT Q1 2002

*Market Definition = N5A1 Atypical Antipsychotics

PRESCRIPTION COVERAGE EXPENSES IN LITHUANIA

36,333,752 (12%)

25,8 (8%)

430

321355

324

0

100

200

300

400

500

1998 1999 2000 2001

Ex

pe

nd

itu

re L

T M

expenditure for covered medications, mln. Lt covered psychotropic medications, mln. Lt.

IN-PATIENT PSYCHIATRIC TREATMENT IN LITHUANIA

32,431,9

32,532,8

34,6

30

31

32

33

34

35

1997 1998 1999 2000 2001

Av

ara

ge

ho

sp

ita

l sta

y (

in d

ay

s)

Avarage hospital stay

27,0

23,2

33,935,6

39,8

20

25

30

35

40

45

1997 1998 1999 2000 2001

Re

ad

mis

sio

ns

(%

)Yearly readmissions (%)

Data of State Mental Health Centre of Lithuania

TOTAL NUMBER OF BEDS IN MENTAL HOSPITALS IN LITHUANIA

371838093824

4150

5380

3510

3000

4000

5000

6000

1991 1997 1998 1999 2000 2001

Nu

mb

er

of

be

ds

Data of State Mental Health Centre of Lithuania

NUMBER OF DISABLED DUE TO SCHIZOPHRENIA AND MENTAL RETARDATION

IN LITHUANIA

11141 11138 11217 11286

10771

82028219

800480797745

7500

8500

9500

10500

11500

1997 1998 1999 2000 2001

Schizophrenia

Mental retardation

Data of State Mental Health Centre