Nordic prescription registers Finland Leena K Saastamoinen The Social Insurance Institution (Kela) Finland NorPEN 12.-13. October, 2011

Essential demographics Size of population on July 31st 2011 5 388 417 See Statistics Finland http://www.stat.fi/til/vrm_en.html Certain population data is available also from Kela, e.g. control population

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

Helsinki

Prescription Register in Finland Since 1994 Whole population (5.4 mio) For drug reimbursement purposes

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

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 Additional refund after yearly ceiling (EUR cent) DDD Number of DDD’s in the purchase Other Dose dispensing Generic substitution, switching

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 %)

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

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

Data on diagnoses Data on hospitalisation from THL since 1969 (Poistoilmoitusrekisteri, hoitoilmoitusrekisteri HILMO) Data on open care contacts, AVOHILMO since 2011 (THL)

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...

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)

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/161109114227HJ?OpenDocument THL (In English): http://retki.stakes.fi/EN/Permitsanddataprotection/ApplicationMSH/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?)

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, Helin-Salmivaara 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 concordance between self-reported medication and official prescription database information. Eur J Clin Pharmacol. 2007 Nov;63(11):1069-74