Trends in cost of treatment of lung cancer patients in 2014-2019 in Finland - a descriptive register study.

AIM: The aim of this descriptive study is to analyze the cost for the treatment of NSCLC and SCLC patients (2014-2019) in Finland. The primary objective is to understand recent (2014-2019) cost developments. METHODS: The study is retrospective and based on hospital register data. The study population consists of NSCLC and SCLC patients diagnosed in four out of the five Finnish university hospitals. The final sample included 4047 NSCLC patients and 766 SCLC patients. RESULTS: Cost of the treatment in lung cancer is increasing. Both the average cost of the first 12 months as well as the first 24 months after diagnosis increases over time. For patients diagnosed in 2014, the average cost of the first 24 months was 19,000 €and for those diagnosed in 2015 22,000 €. The annual increase in the nominal 24-month costs was 10.4% for NSCLC and 7.3% for SCLC patients. CONCLUSION: The average cost per patient has increased annually for both NSCLC and SCLC. Possible explanations to the cost increase are increased medicine costs (especially in NSCLC), and the increased percentage of patients being actively treated.

Trends in treatment of non-small cell lung cancer in Finland 2014-2019.

INTRODUCTION: Non-small cell lung cancer (NSCLC) is a leading cause of cancer mortality in the Western world. However, emerging treatment options and more patients directed to active treatments might improve the outcomes. Here, we retrospectively studied the patient characteristics and treatment practices for NSCLC in Finland 2014-2019 with a special focus on changes in trends over time. MATERIAL AND METHODS: The cohort consisted of patients diagnosed with NSCLC in Finland 2014-2018. Cancer treatments for the patients were followed until the end of 2019. The data, both structured and unstructured, were collected from electronic medical records of four university hospitals in Finland. RESULTS: Of the study population (n = 4047), 65% had adenocarcinoma and 29% squamous cell carcinoma. The share of patients who had not received any active treatment (except palliative radiotherapy) decreased from 32% to 18% between 2014-18. The percentage of patients receiving surgery increased slightly from 22.7% to 24% and for patients receiving chemotherapy or immuno-oncological (IO) treatments from 29% to 41.2% and from 0.8% to 8%, respectively between, 2014-18. However, the time of treatment for patients receiving systemic cancer treatments did not change during the same time period. DISCUSSION: The current study suggests a trend in NSCLC towards more active treatment approaches in 2014-18.

The Finnish experience to save asthma costs by improving care in 1987-2013.

The Finnish National Asthma Program 1994-2004 markedly improved asthma care in the 1990s. We evaluated the changes in costs during 26 years from 1987 to 2013. Direct and indirect costs were calculated by using data from national registries. Costs from both the societal and patient perspectives were included. The costs were based on patients with persistent, physician-diagnosed asthma verified by lung function measurements. We constructed minimum and maximum scenarios to assess the effect of improved asthma care on total costs. The number of patients with persistent asthma in the national drug reimbursement register increased from 83,000 to 247,583. Improved asthma control reduced health care use and disability, resulting in major cost savings. Despite a 3-fold increase in patients, the total costs decreased by 14%, from €222 million to €191 million. Costs for medication and primary care visits increased, but overall annual costs per patient decreased by 72%, from €2656 to €749. The theoretical total cost savings for 2013, comparing actual with predicted costs, were between €120 and €475 million, depending on the scenario used. The Finnish Asthma Program resulted in significant cost savings at both the societal and patient levels during a 26-year period.

Contrasting healthcare costs of COPD and asthma in elderly.

BACKGROUND: Caring for ageing populations creates new challenges for society. Obstructive pulmonary diseases, asthma and especially COPD, are responsible for considerable morbidity, mortality, and financial costs in the elderly. We present the change in the burden of asthma and COPD in those aged ≥60 years in Finland from 1996 to 2018. METHODS: We collected national register data from 1996 to 2018 from Statistics Finland, Care Register for Health Care, and the Social Insurance Institution. We estimated the prevalence of asthma and severe COPD, use of healthcare, social services, reimbursed inhalation medications, and societal costs. RESULTS: In subjects aged ≥60 years, the prevalence was 8% for asthma with reimbursed medication and 0·7% for severe COPD in 2018. In 1996-2018, total costs increased from 33 M€ to 58 M€ (+57%) for asthma and decreased from 38 M€ to 30 M€ (-27%) for COPD. Costs per patient decreased for asthma from 720 € to 460 € (-57%) and remained stable for COPD (2700 € in 2018). Potential years of life lost (PYLL) increased in COPD from 5000 to 6400 (+28%) and the number of emergency department visits increased from 3700 to 6000 (+62%). CONCLUSIONS: In a population aged ≥60 years, the total burden caused by asthma decreased but remained stable and high in COPD. PYLL and visits in emergency care increased in COPD.

Long-term surveillance of rotavirus vaccination after implementation of a national immunization program in Finland (2008-2018).

BACKGROUND: Rotavirus (RV) vaccination was included in the Finnish National immunization Program (NIP) in 2009. RotaTeq (RV5) has been used exclusively with a national average vaccination coverage rate (VCR) of > 90%. While previous studies have demonstrated that inpatient rotavirus gastroenteritis (RVGE) admissions declined by as much as 96% in Finnish children ≤ 5 years old following RV vaccination introduction, no study has evaluated long-term protection after vaccination in Finland. In this study, we analyze incidence of hospital outpatient visits and inpatient admissions of gastroenteritis in children up to 7 years of age. METHODS: We first describe the incidence of RVGE, viral gastroenteritis (VGE), and acute gastroenteritis (AGE) for all Finnish children born during 2008-2011. Children were stratified by the year of birth into not-eligible, partially eligible and rotavirus vaccine-eligible (born in 2008, 2009, 2010 and 2011, respectively). Hospital inpatient and outpatient data was collected from the National Care Register for all children from birth until December 31st, 2018. We also studied RVGE incidence during 2014-2017 for children<3 years of age in municipalities with VCRs of 90% and above and municipalities with VCRs below 90%. RESULTS: RVGE incidence decreased significantly soon after implementation of RV vaccination in the NIP. In vaccine-eligible cohorts, no clear peak incidence in the youngest age groups could be observed, and no RVGE cases were observed beyond 6 years after vaccination, in contrast to vaccine ineligible and partially eligible cohorts. Despite an overall high VCR in Finland, regions with high VCR had lower incidence of RVGE than regions with lower VCR. CONCLUSION: Incidence of RVGE has remained low in all age groups during the 10 years following introduction of RV vaccine in the Finnish NIP. Differences in RVGE incidence were observed in regions with high as compared with lower VCR, highlighting the importance of maintaining high vaccination coverage.

Changes in the societal burden caused by sleep apnoea in Finland from 1996 to 2018: A national registry study.

BACKGROUND: In the current century, sleep apnoea has become a significant public health problem due to the obesity epidemic. To increase awareness, improve diagnostics, and improve treatment, Finland implemented a national sleep apnoea programme from 2002 to 2010. Here, we present changes in the societal burden caused by sleep apnoea from 1996 to 2018. METHODS: National register data were collected from the Care Register for Health Care, Statistics Finland, the Social Insurance Institution of Finland, and the Finnish Centre for Pensions. Disease prevalence, use of healthcare and social services, and societal costs were estimated. FINDINGS: The number of sleep apnoea patients increased in secondary care from 8 600 in 1996 to 61 000 in 2018. There was a continuous increase in outpatient visits in secondary care from 9 700 in 1996 to 122 000 in 2018 (1 160%) and in primary care from 10 000 in 2015 to 29 000 in 2018 (190%). Accordingly, the cumulative annual number of days off work for sleep apnoea increased from 1 100 to 46 000. However, disability pensions for sleep apnoea decreased from 820 to 550 (33%) during the observation period. Societal costs per patient decreased over 50% during the observation period (€2 800 to €1 200). INTERPRETATION: The number of sleep apnoea patients in Finland increased remarkably during the observation period. To control this burden, diagnostic methods and treatment were revised and follow up was reorganised. Consequently, there was a significant decrease in societal costs per patient. The decrease in disability pensions suggests earlier diagnosis and improved treatment. The national sleep apnoea programme was one of the initiators for these improved outcomes. FUNDING: The Finnish Institute for Health and Welfare and the Hospital District of Helsinki and Uusimaa (HUH), Helsinki, Finland.

The annual costs associated with human papillomavirus types 6, 11, 16, and 18 infections in Finland.

OBJECTIVES: It is known that infections with human papillomavirus (HPV) types 6, 11, 16, and 18, cause cervical cancers (CC), cervical intraepithelial neoplastic lesions (types 1 to 3; CIN 1-3), and genital warts (GW). Together with equivocal cytological abnormalities (ECA), these place a considerable burden on society, but the costs and resource usage are not easily estimated. Therefore, we undertook this study to estimate the burden and costs associated with HPV-related diseases. METHODS: We used Finnish registry-based data for CC, CIN 1-3 and ECA. Data on GW were estimated from associated procedures and medications. The annual burden of disease was estimated from hospitalizations, visits to specialists and primary level care, and pharmaceutical use. The evaluation of costs included health care and screening costs, and productivity lost (separately). Due to the data obtained being fragmented, 2 cost scenarios were constructed. RESULTS: The follow-up of ECA appears to be the most important cost driver. GW should not be underestimated as they affect both genders at an early age. CONCLUSIONS: HPV infections are a burden to society, not only as a result of cancer-related costs, but also costs related to other diseases and indirect costs in the form of lost productivity.

Outcomes of lipid control in secondary prevention of coronary artery disease in Finland: A 24-month follow-up after acute coronary syndrome.

BACKGROUND AND AIMS: Ischemic heart diseases are the main cause of death worldwide, therefore secondary prevention and treatment of coronary artery disease (CAD) are highly significant for public health and mortality. The objective of this study is to evaluate LDL cholesterol (LDL-C) levels as outcomes of secondary prevention of CAD in Finland up to 24 months after being diagnosed with acute coronary syndrome (ACS). This retrospective analysis of patients with ACS was conducted in two areas of Finland that have a combined population of 400,000. METHODS: The data used in the study covered all outpatient visits, inpatient episodes, prescriptions and LDL-C results for ACS patients during 2011-2015. To evaluate the outcome of the prevention, three separate measurements of patients' LDL-C levels were considered: baseline, first follow-up and final follow-up. The factors associated with reaching treatment goal were identified using logistic regression analysis. RESULTS: 32% of ACS patients achieved the treatment goal (LDL-C <1.8 mmol/l) at the end of the 24-month follow-up period, but 21% of patients fluctuated between being on and above target. CONCLUSION: Two thirds of CAD patients with ACS and on statin therapy do not achieve LDL-C treatment target recommended by the guidelines. Since LDL-C levels fluctuate in the follow-up, a low level during the first 12 months after the acute event does not guarantee the maintenance of the results in the long term. Hence, LDL-C levels should be monitored at least on an yearly basis on follow-ups, and treatment adapted accordingly.

Annual costs of chronic obstructive pulmonary disease in Finland during 1996-2006 and a prediction model for 2007-2030.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major burden for the health care system, but the exact costs are difficult to estimate and there are insufficient data available on past and future time trends of COPD-related costs. AIMS: The aim of the study was to calculate COPD-related costs in Finland during the years 1996-2006 and estimate future costs for the years 2007-2030. METHODS: COPD-related direct and indirect costs in the public health care sector of the whole of Finland during the years 1996-2006 were retrieved from national registers. In addition, we made a mathematical prediction model on COPD costs for the years 2007-2030 on the basis of population projection and changes in smoking habits. RESULTS: The total annual COPD-related costs amounted to about 100-110 million Euros in 1996-2006, with no obvious change, but there was a slight decrease in direct costs and an increase in indirect costs during these years. The estimation model predicted a 60% increase up to 166 million Euros in COPD-related annual costs by the year 2030. This is caused almost entirely by an increase in direct health care costs that reflect the predicted ageing of the Finnish population, as older age is a significant factor that increases the need for hospitalisation. CONCLUSIONS: The total annual COPD-related costs in Finland have been stable during the years 1996-2006, but if management strategies are not changed a significant increase in direct costs is expected by the year 2030 due to ageing of the population.