Research department
Nordic prescription
registers
Finland
Leena K Saastamoinen
The Social Insurance Institution (Kela)
Finland
NorPEN 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.htm
l
• 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
Research department
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
(EUR cent)
Additional refund after yearly ceiling
•
DDD
Number of DDD’s in the purchase
Other
•
Dose dispensing
•
Generic substitution, switching
Research department
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 %)
Research department
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
Research department
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
Research department
Data on diagnoses
• Data on hospitalisation from THL
since 1969
(Poistoilmoitusrekisteri,
hoitoilmoitusrekisteri HILMO)
• Data on open care contacts,
AVOHILMO since 2011 (THL)
Research department
Data on diagnoses

Special reimbursement
eligibility register
 Kela
 Since 1964
 Person code, age, gender,
place of residence...
 Number of disease
 Diagnosis complete since 2000
 E.g. Cancers, BP, asthma,
diabetes...
Research department
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)
Research department
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/161109114
227HJ?OpenDocument
• THL (In English):
http://retki.stakes.fi/EN/Permitsanddataprotection/Appli
cationMSH/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, HelinSalmivaara 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