Research department

Nordic prescription registersFinland

Leena K SaastamoinenThe Social Insurance Institution (Kela)

FinlandNorPEN 12.-13. October, 2011

Research department

Essential demographics

• Size of population on July 31st 2011

5 388 417• See Statistics Finland

http://www.stat.fi/til/vrm_en.html• Certain population data is available also

from Kela, e.g. control population

Research department

Relevant host institution(s)

• The Social Insurance Institution (Kansaneläkelaitos, Kela) – Prescription register– Special Reimbursement Register

• National Institute of Health and Welfare (Terveyden ja hyvinvoinnin laitos, THL) – Hospitalisation

• Statistics Finland

Research department

Helsinki

Research department

Prescription Register in Finland

• Since 1994• Whole population (5.4 mio)• For drug reimbursement purposes

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Prescription variables, what is covered?Drug user• HETU ID-code• IKA Age at the end of the yea• SP Gender• SYNTPV Date of birth• SVUOSI Year of birth• KUOLPV Date of death• ASKU Municipality of residence at the end of the year• SHP Hospital district at the end of the year

Prescriber • SVNUMERONumber of the doctor • ERKOT Main speciality of the doctor during the year• TYOP Data on working place in the year in question

Research department

Prescription variables, what is covered?Drug• ATC ATC-code• OTPVM Purchase date• VNRO Nordic product number (Package size, strength,

pharmaceutical form available under product number)

• PLKM Number of purchased packages• KUST Cost of the drug (EUR cent)• KORV Reimbursement/refund of the drug (EUR cent)• KAKORV Additional refund after yearly ceiling (EUR cent)• DDD Number of DDD’s in the purchase

Other• Dose dispensing• Generic substitution, switching

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Prescription variables, what is not covered?• Dosing instruction (only in free text for

latest 1,5 years)• Indication (only in free text for latest

1,5 years, if the doctor has recorded any indication – e.g. SSRI: no indication in 16 %, tricyclics: 55 %, others: 23 %)

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Coverage of prescription database

• All residents• Only reimbursed prescriptions

(including clinical nutrients and basic ointments for long term care)

• Not covered: • OTC drugs• Drugs prescribed in hospitals

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Groups poorly covered

• Oral contraceptives• New active substances which are not

yet included in reimbursement system• Eye and ear drops for short term use• Small packages of benzodiazepines

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Data on diagnoses

• Data on hospitalisation from THL since 1969 (Poistoilmoitusrekisteri, hoitoilmoitusrekisteri HILMO)

• Data on open care contacts, AVOHILMO since 2011 (THL)

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Data on diagnoses

Special reimbursement eligibility registerKelaSince 1964Person code, age, gender, place of

residence...Number of diseaseDiagnosis complete since 2000E.g. Cancers, BP, asthma, diabetes...

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Linkage

• Individual level data available for scientific research

• Permissions have to be applied from each institution

• Data is e.g. Transferred from Kela to THL and linked there before submitting to the researchers

• If possible, the person codes are removed after linking (the key can be saved)

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Practicalitities

Approvals• Ethics approval are not required for plain registry studies• Approvals from each institution• Kela (in English):

http://www.kela.fi/in/internet/english.nsf/NET/161109114227HJ?OpenDocument

• THL (In English): http://retki.stakes.fi/EN/Permitsanddataprotection/ApplicationMSH/Applying.htm, application forms in English available from arto.vuori (a) thl.fi

Help• http://retki.stakes.fi/EN/index.htm

Costs• The more data on different years and different data sources, the

more expensive data

Time• 3-4 months from Kela (one year?)

Research department

A few examples of papers• Zoëga H, Furu K, Halldórsson M, Thomsen PH, Sourander A, Martikainen JE. Use of

ADHD drugs in the Nordic countries: a population-based comparison study. Acta Psychiatr Scand. 2011 May;123(5):360-7

• Martikainen JE, Saastamoinen LK, Korhonen MJ, Enlund H, Helin-Salmivaara A. Impact of restricted reimbursement on the use of statins in Finland: a register.based study. Med Care. 2010 Sep;48(9):761-6.

• Foulon V, Svala A, Koskinen H, Chen TF, Saastamoinen LK, Bell JS. Impact of regulatory safety warnings on the use of antidepressants among children and adolescents in Finland. J Child Adolesc Psychopharmacol. 2010 Apr;20(2):145-50.

• Rikala M, Hartikainen S, Sulkava R, Korhonen MJ. Validity of the Finnish Prescription Register for measuring psychotropic drug exposures among elderly Finns: a population-based intervention study. Drugs Aging. 2010 Apr 1;27(4):337-49

• Helin-Salmivaara A, Lavikainen PT, Korhonen MJ, Halava H, Martikainen JE, Saastamoinen LK, Virta L, Klaukka T, Huupponen R. Pattern of statin use among 10 cohorts of new users from 1995 to 2004: a register-based nationwide study. Am J Manag Care. 2010 Feb;16(2):116-22

• Koskinen H, Martikainen JE, Maljanen T. Antipsychotics and antidepressants: an analysis of cost growth in Finland from 1999 to 2005. Clin Ther. 2009 Jun;31 Pt 1:1469-77

• Haukka J, Suvisaari J, Tuulio-Henriksson A, Lönnqvist J. High concordance between self-reported medication and official prescription database information. Eur J Clin Pharmacol. 2007 Nov;63(11):1069-74