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Browsing by Subject "15D-mittari"

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  • Alakoski, Anna (2012)
    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.
  • Sinisalo, Aino (2015)
    End stage renal disease (ESRD) burdens both society and patient trough lower quality of life and the cost of treatment, as well as through lost productivity. In 2012, the incidence of ESRD was 81 patients per one million inhabitants in Finland. Annual number of kidney transplantations range from 150 to 210. The costs of specialized medical care, adherence to medication and health related quality of life (HRQoL) of kidney transplant patients were analyzed in this study. The aim of the study was to provide research to support the improvement of the kidney transplant patients' health care process and future research on the cost-effectiveness of kidney transplantation. In addition, the aim was to produce information to support health care decision making and resource allocation. The study population included 320 patients who had received a kidney transplant in HYKS. Of the included patients, 198 answered the questionnaire and 122 formed a control population of which only cost data was available. The cost data was collected from the HUS Ecomed-database. Medication adherence was measured with the BAASIS- and VAS-instruments and the HRQoL with the generic 15D-instrument. Forty-three per cent of the patients were non-adherent. There was no statistical difference in the adherence of patients with different dialysis modalities. The correct timing of taking the immunosuppressive medication proved to be its biggest challenge. The average quality of life for kidney transplant patients was measured at 0.87. There were no statistically significant differences in the 15D scores between adherent and non-adherent patients or different dialysis modalities. Instead, there were statistically significant differences between dialysis modalities in some of the 15 dimensions. The 15D score was on average lower among patients with a higher MRCI-score or a longer dialysis period prior to transplantation. The average cost for the specialized medical care of the kidney transplant patients was 34 331 euros on the year prior to the transplant, 52 834 euros one year after the transplant and 8 537 and 7 791 euros on the second and third year after the transplant, respectively. Average costs for all three years after the transplantation combined were 68 932 euros. Based on the results of this study, non-adherence to medication proved to be a considerable issue for kidney transplant patients. The HRQoL after a kidney transplantation was moderately high, although lower than in the age standardized general population. Adherence to medication, HRQoL or the dialysis modality were not associated with cost of the specialized medical care after the kidney transplantation and there was no single factor associated with these post transplant costs. The strength of the study is a comprehensive longitudinal analysis of special care costs and the factors associated with them. On the other hand, health related quality of life is only measured once, which is a limitation. The cost analysis would have been more comprehensive if all the health care cost and other direct costs such as travel and time cost as well as indirect costs such the loss of productivity had been included.