- Would
you please explain the reimbursement for healthcare
system in Sweden?
In Sweden, there is a cap on the bill from the
pharmacy. Patients never pay more than US$180/year.
So even if patients get Infliximab which costs
several hundreds or thousands of dollars, they
never need to pay more than US$180. The consultation
fee to see a doctor on an outpatient basis is
usually US$24/visit, but there is also a cap
on that which is US$90/year. The government
reimburses anything over that. As an inpatient
in Sweden, it costs US$8-9/day and there is
no cap on that. The government runs most healthcare
institutions and there are only a few private
institutions.
- Are
patients able to receive public funds to help
them financially?
The government covers a large proportion of
the medical bill anyway (see above question).
- Are
UC and CD patients able to take out life insurance
policies offered by private insurance companies?
Yes, they can usually take out life insurance
policies but they may have to pay higher premium,
except if they have mild UC or had had a proctocolectomy
or ileostomy, then they are considered as having
no risks. An ileostomy is not considered as
a handicap in Sweden.
- How
many specialized IBD hospitals are there in
Sweden?
There are no specialized IBD hospitals in Sweden
but there are some IBD clinics. However, there
are IBD units, which are part of a larger Gastroenterology
Department in some hospitals. There are less
than 10 of these hospitals with IBD units (approximately
1/1million population) nationwide. The IBD unit
at Sophiahemmet is probably one of the most
dedicated ones in Sweden.
- What
kinds of common problems do UC and CD patients
face in their daily life?
The
mortality of IBD used to be high 25 years ago,
but recently, the mortality rate is the same
as healthy subjects. In addition, pregnancy
and birth are not substantially affected by
IBD. IBD patients usually work in good positions,
often white-collar jobs and they have families
like everyone. When they have active disease,
then perhaps they have to take a few days off
work but otherwise, they live like everybody
else.
Last
question, do you have any message for our Japanese
IBD patients?
I think there is an opportunity to treat more
aggressively with drugs like IMM (AZ) and topical
corticosteroids. For example, a short course
of corticosteroids (topical) if needed, combined
with IMM (e.g., AZ) is often of great benefit
for CD patients with ileo-colonic involvement.
I am very optimistic about the future because
there are many new drugs in phase II and III
of clinical trials including apheresis (e.g.
Adacolumn), which is a non-toxic type of treatment.
I think the tolerability for Adacolumn type
of treatment is excellent. One has to weigh
the risk/benefit when new therapy is considered.
The advantages for apheresis vs for example
Infliximab (Remicade) is great when the toxicity
profile is assessed. I have 25 years experience
in IBD and the prognosis has never been better.
Also, instead of most patients as in-patients
25 years ago, they are now usually treated as
out-patients. I think this is the “take-home”
message to Japanese IBD patients: Even if more
patients will get IBD (prevalence), the prognosis
is much better now and will probably get even
better. We still do not know the cause of IBD
but as soon as we find out, we can start talking
about curing IBD. I believe we will find the
cause(s) of IBD within the next 10 years.
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Treatment for UC and
CD in Sweden 
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