Jaana E Martikainen

Kela - The Social Insurance Institution of Finland · Research Unit

International literature suggests that co-payment increases are associated with decreased medicine use, although the effects depend on context. We examined the impact of a co-payment increase on the consumption of type 2 antidiabetics in Finland, a country with a comprehensive health and social security system including ceiling mechanisms aiming to...

Background: From October 2018, adalimumab biosimilars could enter the European market. However, in some countries, such as Netherlands, high discounts reported for the originator product may have influenced biosimilar entry. Objectives: The aim of this paper is to provide a European overview of (list) prices of originator adalimumab, before and aft...

Objectives: The youngest children in a classroom are at increased risk of being medicated for attention-deficit/hyperactivity disorder (ADHD). We examined the association between children's birth month and ADHD medication rates in Finland. Methods: Using a population-based study, we analyzed ADHD medication use among children born in 2005 to 200...

Aims: This study examined medication use for attention-deficit/hyperactivity disorder (ADHD) among children and adolescents by gender in Finland during 2008–2018. Methods: Aggregated data on medication use for ADHD from 2008 to 2018 were extracted from the nationwide register on reimbursed prescriptions. The annual prevalence of ADHD medication use...

Background: Since 1994, the Finnish Prescription Register (FPR) has been the main data source for pharmacoepidemiology research in Finland. However, the FPR data are limited to reimbursed dispensations only. Implementation of electronic prescribing started in 2010 and after a stepwise extension, electronic prescribing became mandatory in all healt...

Study objective: Evidence on the cardiotoxicity of nonaspirin nonsteroidal antiinflammatory drugs (NSAIDs), particularly diclofenac and the newer selective cyclooxygenase (COX)-2 inhibitors, has accumulated over the last decade. Our objective was to examine whether the use of NSAIDs in the Nordic countries changed with the emerging evidence, regul...

Available: https://helda.helsinki.fi/bitstream/handle/10138/260964/Tyopapereita145.pdf?sequence=4&isAllowed=y

BACKGROUND: The use of medications to treat attention deficit hyperactivity disorder (ADHD) has increased, but the prevalence of ADHD medication use across different world regions is not known. Our objective was to determine regional and national prevalences of ADHD medication use in children and adults, with a specific focus on time trends in ADHD...

Background: The use of medications to treat attention deficit hyperactivity disorder (ADHD) has increased, but the prevalence of ADHD medication use across different world regions is not known. Our objective was to determine regional and national prevalences of ADHD medication use in children and adults, with a specific focus on time trends in ADHD...

Purpose: To assess pricing and reimbursement policies specific to orphan medicines and the availability and distribution settings of ten recently authorised medicinal products suitable for outpatient care with orphan status and centralised marketing authorisation in Europe, and whether patients receive these products free of charge or have to pay...

Paracetamol (acetaminophen) is one of the most commonly used analgesics in Europe; however, both the safety and efficacy of paracetamol have recently been questioned. Little is known about cross‐national differences in the sales of paracetamol. Using national wholesale statistics and nationwide prescription drug registers, we investigated trends in...

Background Across European countries, differences exist in biosimilar policies, leading to variations in uptake of biosimilars and divergences in savings all over Europe. Objectives The aim of this article is to provide an overview of different initiatives and policies that may influence the uptake of biosimilars in different European countries. R...

Brand names of funded biosimilars in different countries in Europe (April 2017). (DOCX)

Questionnaire biosimilar medicines market–The situation in your country. (DOC)

Setting in which biological medicinal products are available in different countries in Europe (April 2017). (DOCX)

Estimating the effects of reforms in advance is an important part of evidence-based and transparent legislative processes. The aim of this study was to describe a microsimulation method created to produce ex ante estimates of pharmaceutical pricing and reimbursement policy reforms. As a case example, the estimates for the 2016 pharmaceutical reimbu...

Tutkimus harvinaislääkkeiden saavutettavuudesta Euroopassa

Aim: Allergies can worsen asthma symptoms and we used national data to identify allergy medication prescribed for Finnish children and adolescents who used asthma medication. Methods: Register data were available for 13,435 Finnish children aged 0-17 who were entitled to special reimbursement for asthma medication during 2006-2009. Allergy medic...

Purpose: The use of ADHD drugs among adults is controversial and has until recently not been approved for use in adults in most countries. The aim was to investigate use of ADHD drugs (stimulants and atomoxetine) among the entire adult population in the Nordic countries. Methods: We conducted a multinational population-based prescription registe...

Use of stimulants to treat Attention-deficit/hyperactivity disorder (ADHD) has increased over the past two decades and varies substantially between countries. The objective of this multinational population-based study was to examine utilization of ADHD drugs (stimulants and atomoxetine) including co-medication with other psychothropic drugs in the...

Introduction: Drugs are the largest component of the health care costs associated with asthma and allergies in Finland and have increased from 2000 to 2010. Aims and objectives: We studied changes in asthma and allergy drug consumption in the time period from 2008 to 2013 during the Finnish Allergy Program. Methods: The data are based on drug sal...

Pharmaceutical expenditure can be used to measure the economic importance of various medicines. Pharmaceutical expenditure is medicine price multiplied by volume. Both price and volume components are influenced by a range of policy measures. Data gaps related to pharmaceutical expenditure exist for most countries. National databases usually don’t i...

. We aimed to study the prevalence of chronic comorbidities in asthma patients and the costs of health care use associated with asthma with comorbidities. Material and Methods . We analysed the prevalence of the four most common chronic diseases in asthma patients in 2008–2014 in Finland. Prevalence of coronary artery disease, diabetes and dyslipid...

Objectives: To analyze the medium- to long-term impact of generic substitution and the reference price system on the daily cost of antipsychotics in Finland. The additional impact of reference pricing over and above previously implemented generic substitution was also assessed. Methods: An interrupted time series design with a control group and seg...

Background and Objectives Asthma is the most common long-term disease in children and adolescents. In Finland, it has been diagnosed in 5% of children under school age and in 7% of school aged children and adolescents [1]. Based on asthma guidelines short-acting beta2-agonists and inhaled corticosteroids should be the first-line medication for asth...

http://www.julkari.fi/handle/10024/125602

http://urn.fi/URN:ISBN:978-952-302-431-1

How are medicine prices decided upon in European countries? Which challenges do policy makers face? Which role do reimbursement aspects play in the pricing process? Are there communalities and similarities between European countries? This chapter provides information on pharmaceutical pricing policies in 30 European countries, including all 28 Euro...

Background: The objective was to examine cost-related barriers to using health services and prescription medicines in Finland. Methods: A survey that examined adults' experiences of and opinions about the social security system was mailed to a random population-based sample of 5000 Finns aged 18-74 years. The survey assessed households' cost-rel...

AimsTo compare benzodiazepine (BZD) purchases in different groups of mothers of small children.DesignProspective population-based cohort study based on the Finnish social and health care registers.SettingFinnish women of child-bearing age.ParticipantsAll women who gave birth in 2002 in Finland (n = 54 519).MeasurementsLatent class analysis was used...

To assess the impact of reference pricing and extension of generic substitution on the daily cost of antipsychotic drugs in Finland during the first year after its launch. Furthermore, the additional impact of reference pricing on prior implemented generic substitution is assessed. A retrospective analysis was performed between 2006 and 2010. A seg...

Background As a part of the Finnish Allergy Programme 2008-18 we aimed to analyse today’s costs in asthma and allergic diseases as well as their trends in recent years. One of the main objectives of the programme is a 20% decrease in the economic burden due to allergic diseases. Methods We studied outpatient visits and hospital days in specializ...

Purpose: All five Nordic countries have nationwide prescription databases covering all dispensed drugs, with potential for linkage to outcomes. The aim of this review is to present an overview of therapeutic areas studied and methods applied in pharmacoepidemiologic studies using data from these databases. Methods: The study consists of a Medlin...

Pharmaceutical sales totaled an estimated USD 700 billion in OECD countries in 2011, approximately one-fifth of total healthcare spending (5). In the past, pharmaceutical expenditure has increased faster than total healthcare expenditure in many countries. The increase in pharmaceutical expenditure has slowed down in recent years due to the economi...

The Finnish Asthma Programme 1994-2004 focused on early intervention and disease control, thereby resulting in a significant reduction of asthma morbidity. During the follow-up period from 2000 to 2010, the number of hospital days continued to fall by 54%. Patients ≥65 years, especially women, accounted for 39% of the hospital days, and they need a...

Background and Objectives: The use of antidepressants has increased in many Western countries among children, adolescents and young adults. The objective of this study was to analyse changes in incidence and prevalence of antidepressant use among patients aged 0 to 26 years from year 1997 to 2007. Methods: This is an observational population-based...

To compare national use of attention-deficit/hyperactivity disorder (ADHD) drugs between five Nordic countries. A population-based drug utilisation study based on nationwide prescription databases, covering in total 24 919 145 individuals in 2007. ADHD drugs defined according to the World Health Organization Anatomic Therapeutic Chemical classifica...

Unit of Clinical Pharmacology, Turku University Ho spital, Turku, Finland Corresponding author: Maarit Jaana Korhonen Department of Pharmacology, Drug Development and Th erapeutics, University of Turku, 20014 Turun yliopisto, Finland Tel. +358 40 357 2081 Fax. +358 17 162 424 E-mail: maarit.korhonen@utu.fi Word count: 600

Suom Lääkäril 2011; 66; 568–571.

Introduction: European countries need to learn from each other to address unsustainable increases in pharmaceutical expenditures. Objective: To assess the influence of the many supply and demand-side initiatives introduced across Europe to enhance prescribing efficiency in ambulatory care. As a result provide future guidance to countries. Metho...

New and expensive medicines are a driving force behind growth in medicine costs, and policies promoting use of less expensive products have been widely introduced. This study investigated the short-term consequences of the restricted reimbursement of expensive statins (atorvastatin and rosuvastatin) on the use of statins in Finland. Data on patient...

To analyze differences in the pattern of statin use among 10 consecutive yearly cohorts of new users in Finland. Retrospective cohort study based on administrative claims data. New users of statins from January 1, 1995, to December 31, 2004, were captured from a nationwide prescription register, and the pattern of statin use was observed until Dece...

Suom Lääkäril 2010; 65: 1847–1850.

Julkaisussa: Hämäläinen U, Kangas O, toim. Perhepiirissä. Helsinki: Kela, 2010: 216–235.

The Nordic countries have a long tradition of registry-based epidemiological research. Many population-based health registries were established in the 1960s, with use of unique personal identifiers facilitating linkage between registries. In recent years, each country has established a national database to track prescription drugs dispensed to indi...

Basic Clin Pharmacol Toxicol 2009; 105 (suppl. 1): 37.

Basic Clin Pharmacol Toxicol 2009; 105 (suppl. 1): 35.

Antipsychotics and antidepressants are among the fastest-growing therapeutic classes, but the reasons behind recent cost growth are not clear. The aim of this study was to assess the explicit factors behind ambulatory antipsychotic and antidepressant cost growth in Finland, as well as the relative importance of the factors associated with the drug...

There is little empirical information about the role of new chemical entities (NCEs) and to what extent they are being adopted in modern health care. We aimed to investigate which NCEs were launched in Finland during the years 1996 through 2005 and how they penetrated the market in Finland. NCEs were identified from Finnish drug compendiums and ver...

Preventive statin therapy is often recommended as lifelong treatment. The aim of this study was to analyze persistence with statin therapy over a decade of use and to identify factors associated with its discontinuation. Persistence with therapy among new users of statins in 1995 was followed up until December 31, 2005, in Finland using the nationw...

Sosiaalivakuutus 2008; 46 (1): 12-14.

Copayments are common measures intended to control drug expenditures and promote rational prescribing. In Finland, new antiglaucoma drugs start with a high copayment, but once sufficient clinical experience is available, they are reevaluated and can receive a lower copayment status. This study assessed the effect of changes in copayment level on th...

Eur J Pharmacol 2007; 63: 97–98.

High prices of new pharmaceuticals play an important part in rapidly rising pharmaceutical costs. Many countries try to curb these rising costs through control of the price of reimbursable medicines. There is, however, little internationally comparable information on prices. This study aimed to examine the prices of new, reimbursable pharmaceutical...

Prescribing drugs to pregnant women requires the balancing of benefits and risks. Only a small proportion of drugs are known to be harmful to the fetus, but for the vast majority of drugs little evidence of fetal safety exists. To determine the prescription pattern of potentially and clearly harmful prescription drugs during pregnancy with referenc...

This article describes an innovative method to identify infertility interventions from drug reimbursement data, which did not contain diagnoses. An algorithm of usual infertility care steps was designed and information on drug prescriptions were retrieved from the Drug Reimbursement Register and linked to a register covering examinations and interv...

Background: There is uncertainty about the level of utilization and expenditure for medicines in the European Union (EU), making assessment of their impact on public health difficult. Our aim is to develop indicators to monitor price, expenditure and utilization of medicinal products in the EU, so as to facilitate comparisons. Methods: There are fo...

To examine the use of prescription drugs in Finnish women before and during pregnancy and lactation. A register-based study linking four nation-wide registers in Finland: the Maternal Grants Register, the Drug Prescription Register, and the Special Refund Register (all maintained by the Social Insurance Institution in Finland; KELA), and the Finnis...

130 s. Online publication

Gut 2001; 49 (suppl 11): 15/15.

To explore the frequency of continuous use of over-the-counter (OTC) drugs among the Finnish adult population and the potential for harmful interactions between OTC drugs and prescribed (Rx) drugs. Data were extracted from a 1995-1996 population-based interview survey on health care (n = 10,477, response rate 86%). The drug interaction classificati...

To investigate comorbidity and overall use and costs of medication for all Finnish individuals with diabetes treated with drugs compared with sex- and age-matched control subjects. According to a cross-sectional population study using national registries, 116,224 individuals purchased antidiabetic medications in Finland in 1995. The same number of...

16th International Diabetes Federation Congress, Helsinki 20.-25.7.1997. Diabetologia 1997; 40: suppl 1: A 39.

The consumption of lipid-lowering drugs in Finland and in other Nordic countries increased almost steadily in 1988-1993. The exceptions were the year 1992 in Finland and 1993 in Iceland, when consumption was lower than in the previous year. In both cases the temporary decline in consumption was associated with a reduction in reimbursement for the c...

Changes in the use of prescription drugs were studied both at an individual and a population level in a cohort of Finnish men born 1900-1919. The cohort (1,711 men) was studied for the first time in 1959 as a part of the Seven Countries Study. This study is based on follow-ups carried out in 1984 and 1989. In 1984, 766 men were alive and the partic...

This study investigates the occurrence of potentially harmful drug combinations in a respresentative sample of the Finnish population. As potentially harmful were categorised as those combinations which, according to Hansten are of major clinical significance. The study population was derived from a nation-wide health survey, in which the use of me...

The purpose of this study was to investigate the occurrence of multiuse of prescription drugs and its major determinants among Finnish adults. The data were based on three nationally representative and intercomparable health surveys in 1976, 1978-80, and 1987. The study populations were 16,413 in 1976, 13,138 in 1987, and 7,217 in 1978-80. The simu...

We analysed the use and characteristics of the users of analgesics and anti-inflammatory drugs in Finland. The study involved cross-sectional population surveys in 1976 and 1987. Two nationally representative samples of non-institutionalized Finnish adults aged 15 years or more were drawn from official statistical registers. Participation rates wer...

The sales of antiasthmatics have increased rapidly in the Nordic countries during the 1980s. The causes for this growth in Finland were studied. Four nationwide population surveys show that the prevalence of self-reported asthma has risen, a larger proportion of asthmatic patients are under medication, the number of antiasthmatics per patient has i...

Comparative wholesale statistics from the five Nordic countries show an increase of 15-42% in the total consumption of analgesics and anti-inflammatory drugs (including antirheumatics) in the period 1978-1988. Denmark had the highest total consumption (112 DDD/1000 inhab/day in 1988) and Norway had the lowest (61 DDD/1000 inhab/day). Iceland and Fi...

The extent and factors that influence drug use were studied in two rural cohorts of Finnish men. The men aged between 65 and 84 years belonged to the Finnish study population of the 25-year follow-up of the 'Seven Countries Study'. Of the original 1,711 men in 1959, 766 were still alive in 1984. The participation rate in the follow-up was 93%. Of t...

The prevalence and type of problems in drug taking were studied in a cohort of 65-84 years old Finnish men. Of the original cohort established in 1959, 766 of 1711 (45%) were still alive in 1984. The participation rate in this 25-year follow-up study was 93% (n = 716). The men were interviewed concerning their use of drugs during the preceding thre...

6th European Conference on Health Economics, July 6–9, 2006, Budapest. Eur J Health Economics 2006; 7 (Suppl 1): S54. Abstract.

24th Annual International Conference on Pharmacoepidemiology & Therapeutic Risk Management. Kööpenhamina 17.–20.8.2008. Pharmacoepidemiol Drug Saf 2008; 17: S42. Abstrakti, posteri.

Julkaisussa: Hämeen-Anttila K, Katajavuori N, toim. Yhteiskunnallinen lääketutkimus – ideasta näyttöön. Helsinki: Palmenia, 2008: 98–112.