Browsing by Subject "kustannukset"

Prostate cancer is the most common cancer in men in Finland. Health care costs increase annually and cost of cancer is significant to the society. Because resources are scarce more information is needed about the costs of diseases as well as treatment effectiveness. In addition to clinical effectiveness it is important to assess the value of healthcare technologies from the patient's point of view by measuring the treatment's effect on patients' quality of life. In this thesis a literature review was made on the following topics: cost of treating prostate cancer, prostate cancer patients' quality of life and cost-effectiveness of prostate cancer. The aim of the research was to determine what the drug costs are in relation to the total cost of treatment for prostate cancer in different stages of the disease and assess how the quality of life changes during the first year of treatment depending on the form of treatment. Drug costs were calculated from the health care payer's perspective in a six month cross-sectional study. The study population included a total of 629 prostate cancer patients treated in the Helsinki and Uudenmaa hospital district (HUS). The quality of life study population (N=367) was different of that used to calculate drug costs. The quality of life was measured according to an ongoing cost-effectiveness research at HUS. It was measured with 15D-instrument before receiving cancer treatment and three, six and twelve months after the beginning of treatment. Drug costs in relation to the total cost of prostate cancer treatment were significant. In patients with meta-static cancer drugs were 53 % of the total cost of cancer treatment. In remission patients the total costs of cancer treatment were the lowest compared to other diseases stages, but drug costs were still 30 % of the total costs. For patients receiving palliative treatment, local or relapse cancer patients, and patients whose cancer was just diagnosed, the total drug costs were 19%, 13% and 0%, respectively. Policlinic visits and policlinic procedures were also a significant cause of the total costs. Quality of life of prostate cancer patients is incredibly good compared to age-standardized population. However the patients' quality of life decreases statistically and clinically significantly during the first year of treatment. Before treatment 15D score was 0,91 and after 12 months it was 0,88. When assessed in different treatment groups the quality of life decreased the least in patients treated with waiting. The largest statistically significant change occurred in patients treated with radiation. The strength of the study is that the costs were calculated per patient according to real resource use. The study also had limitations. The costs of primary care were not included in the calculations. Also cancer related pain medication, depression and erectile dysfunction drugs should be included in the drug costs. The follow-up time of measuring quality of life was too short. In the future it would be important to study the cost-effectiveness of medication as well as the cost-effectiveness of the different forms of treatment in prostate cancer.

Rheumatoid arthritis (RA) is a chronic autoimmune disease with prevalence around 0.8 % in Finland. Joint inflammation causes pain, tenderness and swelling in joint as well as loss of functional and work capacity. Patients need healthcare resources and medical treatments cause substantial costs to patient and society. Severity of RA can be measured by Disease Activity Score (DAS28) and Health Assessment Questionnaire (HAQ). Previous studies suggest these measures are related to higher direct and indirect cost. The aims of this study are to determine cost of RA in Finland and analyse cost by disease activity and functional disability. Literature review was performed by using some methods from systematic reviews to identify previous studies examining cost of RA by DAS28 and HAQ scores. Secondly in this master thesis was made a quantitative cost analysis which study population was identified from the National register for Biologics in Finland (ROB-FIN) and patient records of the Central Finland Central Hospital. The cost data for direct and productivity costs was received from Finnish national registries. Costs were determined from the followed six months after patients' (N=2285) first routine outpatient visit to specialized healthcare. Distribution of costs was examined by DAS28 and HAQ score based classification. Additionally cost related to RA was determined separately between biologic and non-biologic drug users. Total average costs of the study population were 11 720 € biannually. Direct costs, productivity costs and total costs were higher for patients with higher DAS28 and HAQ scores. Increase in average total costs between best and worst DAS28 and HAQ classifications were 7817 -15 838 € and 8545 - 16 718 €, respectively. In the cost categories changes in both directions were detected between different DAS28 and HAQ score classifications. Drug costs comprised largest part of direct costs (56 %). RA related average total costs increased from best to worst DAS28 and HAQ class for both biologic and non-biologic drug users (p<0,01). Similar study based real life register data is not previous made in Finland. Studies in other countries can`t be directly adapted to Finnish healthcare system, treatment traditions and productivity costs. This study provides information for real-life cots of RA and how they are related to disease activity and functional disability. This information can be used in modelling of cost-effectiveness.

In the United States pharmacists have prescribed medicines and managed patient's drug therapy since the 1970s, and in the United Kingdom pharmacists have been authorization to prescribe medications since 2003. The discussion about the right of Masters of Science in Pharmacy will be renewed prescriptions during the last decade in Finland but few Finnish studies have been published from the subject. In the document Medicines Policy 2020 published by Ministry of Social Affairs and Health states that by prescribing should be used cost-effective modes of operation. The knowledge about pharmacist prescribing benefits and costs, and also prescribing practice in Finland, is needed to evaluate the cost-effectiveness of pharmacists' authorization to prescribe and to support the decision-making concerning pharmacist prescribing. The aim of this master's thesis is to gather all existing knowledge about the economic and other effects of pharmacist prescribing using a systematic literature review method. The aim of theoretical part of this master's thesis is to explain the Finnish prescribing, the participation of pharmacists in drug therapy management in Finland and internationally pharmacist prescribing. The empirical part of this master's thesis is also to assess the quality of the studies of pharmacist prescribing benefits and costs using quality assessment checklists. In addition, this thesis describes the principles of the cost and benefit analyses, economic evaluations and systematic literature reviews. As a result of the literature search were found 1825 references. Based on the inclusion and exclusion criteria, 17 studies were selected to include in the systematic review. Of these studies three were economic assessments, 8 randomized controlled trials and 6 observational studies. The quality of these studies was assessed using four quality assessment checklists. On the basis of a systematic literature review pharmacist prescribing has been studied in the treatment of type 2 diabetes, hypertension, dyslipidemia, anticoagulation, chronic pain, emergency contraception and minor ailments and renewal of long-term medicines. Pharmacists reduced blood pressure by providing follow-up care with prescribing compared with the usual care, but not compared with the case management, which does not include prescribing. In addition, the follow-up care was to improve the treatment results of type II diabetes. The results obtained in the care of dyslipidemia were partly unclear. In the clinic follow-up care with prescribing could be reduced LDL-cholesterol, but not the risk of cardiovascular disease compared with the control group. In the pharmacy follow-up care had no effect on the treatment of patients with LDL-cholesterol compared with the control group. In addition, pharmacist prescribing improved how well patients stayed within INR target range. Pharmacist medication review with pharmacist prescribing achieved in the care of chronic pain patients differed few from the results of pharmacist medication review with feedback for a general practitioner. Pharmacist prescribing could reduce errors in inpatient medication compared with usual care. Much uncertainty is connected to the results of the study. The limited amount of studies, heterogeneity of the studies and methodological quality make the evaluation of real effects more difficult. The included studies of pharmacist prescribing were so heterogeneous. In addition treated disease, assessed benefits and scope of working environment were varied in included studies. Pharmacist prescribing was often studied as part of other care or pharmaceutical service, such as chronic disease management or medication review. The quality assessment of the included studies revealed several sources of bias. The available research information is the insufficient reliable evaluation of economic and other effects of pharmacist prescribing and the need for the further research is big.

Reducing global carbon dioxide emissions is one of the main targets in the fight against climate change. Forests are important carbon pools and the arid regions of the world hold a great carbon sequestration potential. Dryland afforestation could play a considerable part in climate change mitigation. The aim of this study is to understand plantation forestry and the costs of afforestation work in arid and semi-arid regions. The main objective of the study is to estimate the establishment costs of 5.000-hectare irrigated forest plantation in Morocco, planned by the Finnish energy company St1. The plantation establishment costs are consisted of labor factors, such as preparing and mapping the cultivated area, fencing, seedling production, tillage, planting and aftercare, and other maintenance operation. The irrigation cost consist of developing the irrigation system, operation and maintenance costs and the price of desalinated seawater used in the plantation. The research timeframe was set to be from 0 to 5 years, assuming that this period covers the major cost factors of the plantation establishment. According to the results, the total establishment cost of the St1’s 5.000-hectare forest plantation, planned in Morocco, is estimated to be approximately EUR39 million and the cost per hectare around EUR7800. The total cost of cultivation is estimated to be about EUR18 million and the total cost of irrigation in the first four years are around EUR21 million.

Työn tavoitteena on selvittää, miten valittujen sekajätteen käsittelyvaihtoehtojen yksikkö- ja nettoyksikkökustannukset käyttäytyvät laitoskapasiteetin suhteen. Lisäksi selvitetään, miten mahdollisesti tulevaisuudessa asetettava jätteenpolttovero voisi vaikuttaa käsittelyvaihtoehtojen kannattavuuteen. Keskeisenä tavoitteena on myös tuottaa yleisemmällä tasolla tietoa sekajätteen laitosmaisesta käsittelystä sekä eri vaihtoehtojen kustannuksista ja tuloista. Työssä tarkasteltavat käsittelyvaihtoehdot ovat arinapoltto, leijupetipoltto, mekaaninen käsittely ja kompostointi sekä mekaaninen käsittely ja mädätys. Työssä muodostetut yksikkö- ja nettoyksikkökustannuskuvaajat noudattelevat pääosin kasvavien skaalatuottojen mukaista muotoa. Vaihtoehdoille lasketut yksikkö- ja nettoyksikkökustannukset pienenevät laitoskapasiteetin kasvaessa. Poikkeuksena on arinapoltto, jonka yksikkö- ja nettoyksikkökustannukset lähtevät loivaan nousuun suurimmissa kapasiteettiluokissa noin 240 000 t/a jälkeen. Tulokset osoittavat, että jätteenpolttovaihtoehdot ovat nettoyksikkökustannuksiltaan noin 40 euroa mekaanis-biologisia käsittelyvaihtoehtoja edullisempia. Sekä jätteenpolttovaihtoehdot että mekaanisbiologiset vaihtoehdot ovat yksikkö- ja nettoyksikkökustannuksiltaan keskenään hyvin samansuuruisia. Herkkyystarkastelussa tehdyt muutokset eivät vaikuta merkittävästi tuloksiin. Jätteenpolttoveron vaikutusta tutkitaan työssä lisäämällä arinapoltto- ja leijupetipolttovaihtoehdoille lisäkustannuksiksi eri veron tasoja (6,6 e/t; 11,6 e/t; 55 e/t). Polttovero nostaa jätteenpolttovaihtoehtojen nettoyksikkökustannuksia, jolloin mekaanis-biologisten käsittelyvaihtoehtojen kilpailukyky paranee. Jätteenpolttoveron oletetut alemmat tasot (6,6 e/t ja 11,6 e/t) eivät vaikuta juurikaan tarkasteltavien vaihtoehtojen keskinäiseen järjestykseen. Korkein verontaso 55 e/t sen sijaan nostaa jätteenpolttovaihtoehdot nettoyksikkökustannuksiltaan mekaanis-biologisia vaihtoehtoja hieman kalliimmiksi. Kyseisellä veron tasolla on siis mahdollista, että sekajätteen käsittelyssä siirryttäisiin suosimaan mekaanis-biologisia vaihtoehtoja. Työn tulokset kuvaavat keskimääräisiä nettokustannuksia nimenomaisilla käsittelyvaihtoehdoilla. Jätehuollon ratkaisut ovat kuitenkin aina yksilöllisiä. Tästä syystä tuloksia ei voida yksinomaan käyttää harkittaessa jätehuollon ratkaisuja. Yhteiskunnallisesti optimaalista jätehuoltoa suunniteltaessa olisi huomioitava työn näkökulmaa laajemmin koko jätehuoltoketjun kustannukset sekä ulkoisvaikutukset.