Browsing by discipline "Socialfarmaci"

Patient safety is a part of quality and safety of care. Patient safety is defined as freedom for a patient from unnecessary harm or potential harm associated with healthcare. Patient safety covers safety of care, medication safety and safety of devices. Different authorities have promoted patient safety in Finland. The Ministry of Social Affairs and Health set up the Steering Group for the Promotion of Patient Safety for a term extending from 1 November 2006 to 31 October 2009 to coordinate the work for promoting patient safety and to evaluate related development needs at the national level. It has published a national Patient Safety Strategy for the years 2009-2013. Patient safety is also included in the Health Care Act. The National Institute for Welfare and Health (THL) has a Finnish national programme on patient safety: Patient Safety with Skills. Other authorities promoting patient safety in Finland are Finnish Medicines Agency (Fimea) and National Supervisory Authority for Welfare and Health (Valvira). Many studies are related to Patient Safety. In the Seminar of Patient Safety Research 2011 studies were separated to following categories: Patient Safety Culture as a Challenge for Organisations, Medication Safety, Safeguard of Care, Preparation for Patient Safety, Learning of Patient Safety, Control of Patient Documents and Financing of Patient Safety. The aim of this study is to explore Finnish patient safety studies. This study was conducted by using an electronic survey. The survey was sent to members of Finnish Patient Safety Society and a mailing list of Patient Safety Network. The survey was also sent to attendees of the Seminar of Patient Safety Research 2011. Altogether 81 responses were obtained. A patient safety research had been done in 60 per cent of organizations. A patient safety research will be done in 62 per cent of organizations. 10 per cent of the researches were meant for the internal use of the organization but were also published in Finland and abroad. 21 per cent of the researches were published in Finland and abroad. 18 per cent of the researches were published only in Finland and 12 per cent only abroad. 25 per cent of the researches were meant only for the internal use of organization. 14 per cent of the respondents left this question unanswered. A personal grant from a foundation was the most common way of financing for patient safety research. Many different kinds of sponsors were also mentioned. There was co-operation between organizations in 58 per cent of researches. 86 per cent of respondents were interested in a network of patient safety researchers. Using of Reporting System for Safety Incidents in Health Care Organizations (HaiPro) was asked as a detail of this study. HaiPro was used in 65 per cent of organizations. 89 per cent of respondents said that their organization takes advantage of HaiPro but the level of use varied between respondents.

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.

Breast cancer is the most common cancer among women world wide and it´s incidence is constantly growing. The prognosis of local breast cancer is good and patients with metastatic breast cancer are living longer with their disease. The growing survivorship and population of chronically ill breast cancer patients has made quality of life one of the most important aspects in the treatment of breast cancer. Cytotoxic chemotherapy is a widely used treatment for breast cancer. Chemotherapy can cause difficult adverse events, which can affect the patients’ quality of life. Chemotherapy can also relieve the symptoms caused by cancer when used to treat metastatic breast cancer. The aim of this systematic review was to collect the currently available literature about breast cancer patients´ health related quality of life as comprehensively as possible, review the quality of the literature and the effects of chemotherapy on breast cancer patients ‘quality of life. The literature search produced 1666 references. According to the inclusion and exclusion criteria, 107 full text articles were accepted to the final systematic review, 53 of which reported the health related quality of life during adjuvant treatment of breast cancer, and 51 of which reported it during the treatment of advanced or metastatic breast cancer. In addition 3 previous systematic reviews were found. The basic information about the articles was extracted into a table. Articles were heterogeneous regarding their study settings, used quality of life instruments and reporting. Most studies used a disease specific quality of life instrument. The collected literature gave a strong indication of quality of life worsening during adjuvant chemotherapy of breast cancer. This observation was further supported by the previous systematic reviews. Most of the studies reporting the quality of life during chemotherapy for metastatic breast cancer, reported less than clinically important changes during the treatment. A few studies reported clinically important worsening or improvement in quality of life. 11 studies, which were made during or after 21: st century, which reported numerical data from quality of life, which reported predominantly quality of life and which had sample size of at least 100 patients in baseline, were accepted to further assessment of quality of the studies and closer observation. The quality of the studies was assessed with STROBE and CONSORT checklists. The quality of studies was heterogeneous as the studies fulfilled 44.8 % to 86.1 % of the scoring items. Only one randomized controlled trial reported quality of life as their primary end point. The data from these studies supported the previous observation of quality of life worsening during adjuvant chemotherapy of breast cancer. The effect of chemotherapy during metastatic breast cancer on quality of life was not unambiguous. Both clinically meaningful worsening and improvement of quality of life was reported. Breast cancer patients´ health related quality of life has been assessed in multiple publications, but the existing literature is heterogeneous and it´s use in decision making and economic evaluation is not easily feasible. Breast cancer patients´ health related quality of life worsened during adjuvant chemotherapy. Significant improvement in breast cancer patients´ health related quality of life was not observed during chemotherapy for metastatic breast cancer.

Atrial fibrillation is the most common sustained cardiac arythmia. It has been estimated that there will be 14 to 17 million atrial fibrillation patients in Europe by the year 2030. In Finland, there are over 50 000 atrial fibrillation patients. The prevalence of atrial fibrillation increases by age. In addition to age, people who have hearth failure, high blood pressure, coronary artery disease, valvular hearth disease, diabetes mellitus, chronic kidney disease or who suffer from obesity have increased prevalence. Atrial fibrillation is usually not a life threatening condition. However, people who suffer from atrial fibrillation have a greater risk of the stroke compared with people who have normal sinus rhythm. Warfarin has been the standard treatment for preventing the stroke in atrial fibrillation patients. However, there are many inconveniences in warfarin therapy such as food and drug interactions and frequent laboratory visits. Therefore, new oral anticoagulants have been introduced to prevent the stroke in non-valvular atrial fibrillation. These new drugs apixaban, dabigatran, edoxaban and rivaroxaban are more expensive than warfarin. Many people suffer from atrial fibrillation and the number of atrial fibrillation patients is increasing. Due to the expected increase in the number of atrial fibrillation patients in future the costs of the new drugs have led to a concern for their impact on the health care budget. The knowledge of the cost-effectiveness of the new anticoagulants is important for decision making. In this Master's thesis, the cost-effectiveness of rivaroxaban was compared with warfarin for stroke prevention in non-valvular atrial fibrillation. Systematic literature review was used as the study method and 363 studies were screened and 23 of them filled the inclusion criteria. One was a previously published systematic review and 22 were cost-utility studies. All of the cost-utility studies had used decision analytic modelling. The studies were conducted in 13 different countries. In the cost-utility studies included in this systematic review there was a great variability in the cost-effectiveness of rivaroxaban compared with warfarin. Rivaroxaban was cost-effective in more than half of the studies, for example in Belgium, Italy, Norway and Singapore. However, in China, Thailand and Slovenia the cost-effectiveness could not be established. Contradictory cost-effectiveness results were obtained in studies conducted in Germany, Canada and USA. The incremental cost-effectiveness ratio varied from 2580 € to 174915 € per quality adjusted life years (QALY) gained with warfarin over all the 22 cost-utility studies. In studies conducted in Europe the incremental cost effectiveness ratio varied from 4188 € 139163 €/QALY gained. In studies where rivaroxaban, apixaban, dabigatran and warfarin were compared together using an indirect comparison or a network meta-analysis it seemed that rivaroxaban was not the optimal treatment. The most common adverse effect of anticoagulation treatment is bleeding. This complication was included in all the cost-utility studies. However, there was only some uniformity of the bleeding events reported. In most cost-utility studies the acute care cost of intracranial hemorrhages was reported and in many studies, also the long term costs. The cost-utility studies included in this systematic review were quite heterogeneous. Because they were done in different countries their health care settings, treatment options and costs were different. There were also differences in cost-effective models. Modell structure, settings, data and assumptions were different. Due to the heterogeneous nature of the studies, no unambiguous answer could be reached to the question concerning the cost-effectiveness of rivaroxaban compared with warfarin. The quality assessment of the cost-utility studies revealed that some quality criteria were not met. Transferability of the results from one country to the other seemed to be poor. The strength of this master's thesis is the comprehensive literature search concerning the cost-effectiveness of rivaroxaban compared with warfarin. Also, the reporting of methods and results are transparent. There are also limitations in this study. One person was conducting the literature search, data extraction and quality assessment. This might have increased the risk for subjective interpretations and errors.

Stakes ja Lääkehoidon kehittämiskeskus määrittelevät lääkitysturvallisuuden lääkkeiden käyttöön liittyväksi turvallisuudeksi, joka voi vaarantua missä tahansa lääkehoidon vaiheessa. Yksi lääkitysturvallisuuteen vaikuttava lääkehoidon osa-alue on lääkeneuvonta. Koska lääkkeitä käytetään ammattilaisilta saatujen ohjeiden perusteella, on lääkeneuvonnan kehittäminen tärkeää. Lääketietouden lisäämisen ohella lääkeneuvonnalla voidaan vaikuttaa lääkkeiden käyttäjien asenteisiin. Lapsen lääkitykseen kohdistuva lääkeneuvonta on haasteellista, sillä huomio täytyy kiinnittää sekä lapseen että vanhempiin. Tutkimuksessa selvitettiin sairaalasta kotiutettavan lapsipotilaan lääkeneuvonnan sisältöä ja kehitystarpeita sekä lääkeneuvonnan toteuttamiseen vaikuttavia asioita. Lisäksi tutkimuksen avulla selvitettiin vanhemmille kotiutuksen jälkeen ongelmallisia lääkehoitoon liittyviä asioita. Tutkimusaineistona käytettiin HUS:n Lastenklinikalla työskentelevien sairaanhoitajien teemahaastatteluja. Toisena aineistona käytettiin vanhempien osastolle soittamia, lasten kotiutuksen jälkeistä lääkehoitoa koskevia puheluita. Aineiston keräys tapahtui hoitajien avulla heidän kirjatessaan tarkoitusta varten muodostettuun lomakkeeseen ylös ne lääkehoitoa koskevat kysymykset, joita vanhemmat soittavat osastoille kotiutuksen jälkeen. Keräykseen osallistuivat HUS:n infektio-osaston, lastentautien osaston ja munuais- ja elinsiirto-osaston hoitajat. Syyskuun 2009 aikana suoritettuihin teemahaastatteluihin osallistui 10 infektio-osaston sairaanhoitajaa. Kuten aiemmissakin tutkimuksissa on todettu, sairaanhoitajilla on suuri vastuu sairaalassa annettavasta lääkeneuvonnasta. Tutkimustulosten mukaan sairaanhoitajat pyrkivät kattavaan lääkeneuvontaan. He painottavat erityisesti perheen pärjäämistä kotona havainnollistamalla antamaansa neuvontaa kirjallisen materiaalin ja antotekniikkaan liittyvän opetuksen avulla, sekä kiinnittämällä huomiota perheen asenteisiin lääkehoitoa kohtaan. Esteinä lääkeneuvonnan toteuttamiselle koettiin sekä vanhempien että hoitajien kiire, joidenkin vanhempien vääränlainen asenne, hoitajien ja vanhempien kielimuurista johtuvat kommunikaatio-ongelmat, neuvontatilan rauhattomuus sekä hoitajille suunnattujen yhteisten ohjeistuksien puute. Lääkeneuvontaan liittyviksi kehityskohteiksi nousivat sekä vanhemmille että hoitajille suunnatut kirjalliset ohjeet, lääkkeisiin liittyvä lisäkoulutus, neuvonnan ajoitus, neuvontatila ja osastofarmaseutin osallistuminen neuvontaan. Kahden kuukauden tutkimusjakson aikana loka-marraskuussa 2009 kirjattiin osastoilla yhteensä 26 kotiutetun potilaan lääkehoitoa koskenutta puhelua. Infektio-osastolle tulleet yhteydenotot (n=7) koskivat pääasiassa lääkkeen annosteluaikoja ja kuurin tarkkaa kestoa. Yksi puhelu koski haittavaikutuksen ilmaantumista ja yksi antotekniikkaa. Lastentautien osastolle tulleista puheluista (n=11) kymmenen koski insuliinien annostusten muuttamista verensokeriarvojen korjaamiseksi. Munuais- ja elinsiirto-osastolle vanhemmat soittivat yleensä kysyäkseen annosteluun liittyviä erityisasioita, kuten annostelua oksennuksen, väärän lääkkeenantoajan ja yliannoksen jälkeen.Munuais- ja elinsiirto-osastolla puheluita kirjattiin yhteensä kahdeksan. Tutkimuksen mukaan hoitajien antama lääkeneuvonta on perusteellista. Lääkehoitoon liittyviä asioita jää kuitenkin vanhemmille epäselväksi, vaikka huomiota kiinnitetään niihin asioihin, joissa vanhemmat tarvitsevat eniten tukea. Osastoille kehitetyn lääkeneuvontamallin tarkoitus on auttaa hoitajia lääkeneuvonnan toteutuksessa, mutta huomionarvoista olisi myös osastofarmaseutin mahdollisuus osallistua neuvontatilanteeseen. Jatkotutkimuksissa olisi hyvä selvittää, millä tavalla neuvontamallia hyödynnetään neuvonnan toteuttamisessa. Erityisesti lapsille suunnattua lääkeneuvontaa on kehitettävä.

Cholesterol-lowering statins are well-tolerated and effective in prevention of cardiovascular diseases. One of the target groups in treatment of dyslipidaemia is type 2 diabetics, who benefit from reducing cholesterol levels even without a history of cardiovascular disease or high cholesterol levels. Common adverse events associated with statins are myopathy and an increase in liver enzymes. Statins have also been shown to slightly increase the risk of developing type 2 diabetes and increase blood glucose levels. The risk seems to increase with higher doses. Higher doses, however, prevent cardiovascular events more than moderate doses. In this cohort study we assessed the relationship between statins and development of diabetes in a Finnish diabetes prevention study. In addition, we assessed the effects of statins on blood glucose levels. The diabetes risk associated with statins was evaluated by a parametric survival-analysis and the impact on blood glucose levels by a mixture model. The material consisted of the follow-up data from the Diabetes Prevention Study (DPS) from year 1993 to 2009 and along with that statistics on reimbursements for prescription medicines from Kela's reimbursement database. The purpose of DPS was initially to determine if type 2 diabetes can be prevented or delayed by lifestyle intervention. Participants with impaired glucose tolerance were randomly assigned to the intervention group or the control group. The intervention group received intensive and individual counseling on healthy lifestyle while the control group was given general information on health behavior. The study revealed that 36,8 % (n = 182) of the participants had used statins during follow-up. Statin use was more common in the intervention than the control group. Simvastatin was the most used statin and statins had been used for four years on average. Statins were associated with a slight increase in risk of developing diabetes and an increase in fasting plasma glucose and 2 h glucose levels. The risk of diabetes was slighter in the intervention group. Further research is needed to determine the mechanism causing the increase in risk of diabetes, if different statins differ in the extent of risk and if a specific patient group or characteristic is more vulnerable to develop diabetes when exposed to statins. The diabetes risk associated with statins should be taken into account when designing a statin trial. Develoment of diabetes should be a pre-specified endpoint and blood glucose and insulin levels monitored during follow-up.

Various cardiovascular diseases cause a significant portion of the direct healthcare costs. For this reason it is important to develop effective treatment strategies. In the treatment of heart failure maintaining healthy lifestyle is an important issue in addition to medical treatment. The aim of this study is to find out whether multidisciplinary interventions in the treatment of heart failure have had better patient outcomes and/or cost savings compared to the standard care and has a certain intervention method proved itself to be more effective than another. The study focuses on the published material in the last ten years, which is compared with prior systematic review about the same topic. The study was conducted as a systematic review. The literature search was performed on Medline (Ovid), CINAHL and Scopus databases. MeSH-terms and other keywords were used in the search. Search was limited to English-language studies. The article selection was made after 06.01.2004 published studies based on the inclusion and exclusion criteria. A quality assessment was made to the selected articles. Only valid articles exceeding 60 % of the maximum points were selected to this review. Literature search found 848 references, of which quality assessment was carried out for 17 articles. 12 articles were selected to this review. Based on statistical significance mortality rate was reduced only rarely. There were lots of heterogeneity in the results for reducing hospitalizations or improving the quality of life. Hospital or clinic-based interventions seemed to be slightly more effective than other intervention methods. There have been no major changes in the intervention methods, only the methods using mailed materials have been left out. Also the outcomes used are similar to those in the past, although validated instruments in different areas of determining the effectiveness have not been developed. This study found no clear evidence about the effectiveness of the treatment programs. Hospital or clinic-based interventions might be more effective than other intervention methods. There is a lot of research about the issue, but high-quality cost-effectiveness studies are lagging. The results from different studies are hard to integrate because the ways to measure vary. The effectiveness of the intervention depends on many factors, and the sheer increase in the knowledge does not seem to be crucial. For assessing the profitability of multidisciplinary interventions there is a need for a high-quality research about the cost-effectiveness of the treatment programs.

Atypical antipsychotics (AAPs) can be used to treat severe behavioural symptoms of dementia when certain conditions are fulfilled. They are not considered as primary treatment for these symptoms due to their possible serious side effects that are found to be more common in elderly dementia patients. Package leaflets (PLs) are one of the most important sources of medicine information for elderly patients. Evidence-based medicines information is the prerequisite for decision-making and success of pharmacotherapy. The aim of this study was to evaluate the usability and informational content of atypical antipsychotic PLs from the perspective of the elderly. Additionally, the content of medicines information for the elderly found in PLs was compared to similar medicines information targeted to health care professionals (HCPs). Medication Information Design Assessment Scale (MIDAS) was used to evaluate the usability of the most commonly used AAPs (olanzapine, quetiapine and risperidone) among the elderly in Finland. To evaluate the informational content of the PLs and summaries of product characteristics (SmPCs) all the references for the elderly were identified using certain keywords. The informational content concerning elderly from the PLs was compared to information targeted to HCPs in Beer's criteria, Current Care Guideline for memory disorders, Database of medication for the elderly, Martindale and SmPCs. The usability of the PLs in this study was found to be insufficient. The mean MIDAS-credit was 6,4 (n=61; range 5,0-8,0), the maximum credit being 13. Sufficient line spacing and limiting the length of line were among the poorly represented features in the PLs in this study. The occurrence of sufficient font-size varied. Good contrast, headings, usage of upper and lower case in text and bullet points were among the well-represented features. All the PLs included in the content-analysis (n=106) contained at least three references to the elderly. The way the information was presented and how well it stood out from the leaflet varied. The SmPCs contained useful information targeted to elderly that was not found in corresponding PLs. Actions need to be taken to improve the usability and content of product specific medicines information from the perspective of the elderly. Medicine authorities and the pharmaceutical industry have the authority to make these improvements possible. Scientific data and concrete tools are needed to facilitate the change.

Inflammatory bowel diseases are among the fastest growing chronic disease of young people in Europe and they are increasing in Western countries for unknown reasons. Illness often occurs at a young age and the symptoms persist generally throughout life, Crohn's disease and ulcerative colitis are the most common diseases in this category. Inflammatory bowel diseases often cause persistent symptoms and require treatment usually for life, affect the quality of life and the ability to go to work. Conventional treatment usually consists of anti-inflammatory and immunosuppressive drug therapy or surgical intervention. In difficult cases, the biologic drug treatment is used. New biological drug products (TNF-blockers) have improved, in particular in Crohn's disease, a response to treatment. The aim of this study is to provide information about the effectiveness and the costs of the biological treatment in inflammatory bowel diseases. The main results presented are the changes of the quality of life during the observation period measured with the generic and disease-specific HRQoL instruments. The results are also reported on the matter of costs for quality-adjusted life-years gained during the follow-up period. The study consists of FinnIBDQ (inflammatory Bowel Disease Questionnaire) survey (n=2831) and the follow-up survey of the patients who used biologic drug products (n=189). Patients were selected into the follow-up if they reported using the biologic drugs to treat the illness. FinnIBDQ-survey was conducted in 2006/2008 and follow-up questionnaire in 2011. As a generic HRQoL instrument was the 15D-instrument used which is a standardized measure of the health related quality of life. 15D-instrument produces a single index number between 0-1. IBDQ is a disease-specific HRQoL instrument, which consists of 32 questions. The total number of points varies between 32 and 224 from the worst to the best. Patients' medical history, symptoms, medication and health care use were studied in their own partition on the questionnaire. Biological drug therapy group belonged at the baseline (n=148) improved the quality of life (p=0.004) during the follow-up. A disease-specific HRQoL instrument (IBDQ) shows the quality of life has changed in parallel (p=0.003)with the 15D-instrument. Dimensions, where progress was achieved (p<0.05) were the elimination, the usual activities, discomfort and symptoms, as well as vitality and sexual activity. In the research group (n=51), the average cost per patient per QALYs gained during the follow-up period proved to be very high, at over 5 million euro's. During this time, the patient gained an average of 0,01 quality adjusted additional years of life. The evidence of the long-term impact of the biologic drug treatment on the patient's quality of life is still scarce. In most of the research concerned with the benefits of biological treatment, the effectiveness data is derived from the pharmaceutical manufacturers' short-term clinical efficacy studies, or taken from any other quality of life studies.

Ankylosing spondylitis is an inflammatory rheumatoid disease, that is typically diagnosed in young adults. The symptoms include inflammatory back pain, rigidity in the lumbar and thoracic spines, and peripheral inflammations. The incidence of ankylosing spondylitis among northern European population ranges from 0.2 to 0.5%. The mortality rate of people with ankylosing spondylitis is about 50% higher than in the average population. First-line treatment for ankylosing spondylitis includes physiotherapy and NSAIDs. TNF inhibitors are used for patients whose symptoms cannot be controlled with first-line treatment. In Finland, there are five TNF inhibitors indicated for ankylosing spondylitis on the market: infliximab, etanercept, adalimumab, golimumab, and sertolizumab pegol. In 2015, the average medication cost for a patient entitled to reimbursement for TNF inhibitors in Finland was over 12 000 €. The cost-effectiveness of TNF inhibitors in the treatment of ankylosing spondylitis compared to conventional care has been extensively studied, but there is less data on the differences between TNF inhibitors. In this thesis, previously published literature on the cost-effectiveness of TNF inhibitors in the treatment of ankylosing spondylitis was reviewed, and a patient-specific simulation model based on data from the National Register for Biologic Treatment in Finland was conducted. The aim of the simulation was to compare the cost-effectiveness of TNF inhibitors (infliximab, etanercept, adalimumab and golimumab) in the treatment of ankylosing spondylitis as the patient's first biological treatment compared to other TNF inhibitors. The simulation was conducted on a lifetime time horizon and incorporated direct health care and medication costs in 2015 euros. As conclusions of the model, all other TNF inhibitors were found dominant over etanercept. The greatest effectiveness was achieved with golimumab, while the costs were lowest with infliximab. The incremental cost-effectiveness ratio of golimumab compared to infliximab was 63 840 €/QALY. In sensitivity analyzes, the model was found to be very sensitive to TNF inhitors' prices. In addition, sensitivity was also observed for the discount rate and time horizon used.