Browsing by Subject "costs"

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  • Tiihonen, R.; Alaranta, R.; Helkamaa, T.; Nurmi-Lüthje, I.; Kaukonen, J.-P.; Lüthje, P. (2019)
    Background and Aims: Reoperations after operative treatment of hip fracture patients may be associated with higher costs and inferior survival. We examined the acute hospital costs, long-term reoperation rates, and survival of patients with a new hip fracture. Materials and Methods: A total of 490 consecutive new hip fracture patients treated at a single center between 31 December 2004 and 6 December 2006 were analyzed retrospectively. Fractures were classified according to Garden and AO. All medical records were checked manually. The costs of reoperations were calculated using the diagnosis-related groups (DRG)-based prices. Survival analysis was performed using the life-table method. The follow-up time was 10 years. Results: In all, 70/490 patients (14.3%) needed reoperations. Of all reoperations, 34.2% were performed during the first month and 72.9% within 1 year after the primary operation. The hemiarthroplasty dislocation rate was 8.5%, and mechanical failures of osteosynthesis occurred in 6.2%. Alcohol abuse was associated with a heightened risk of reoperation. The mean direct costs of primary fracture care were lower than the mean costs of reoperations (euro7500 vs euro9800). The mortality rate at 10 years was 79.8% among non-reoperated patients and 62.9% among reoperated patients. Conclusions: According to our hypothesis, the cost per patient of reoperation in acute care was 31% higher than the corresponding cost of a primary operation. Reoperations increased the overall immediate costs of index fractures by nearly 20%. One-third of all reoperations were performed during the first month and almost 75% within 1 year after the primary operation.
  • Niemistö, Johanna; Myllyviita, Tanja; Judl, Jáchym; Holma, Anne; Sironen, Susanna; Mattila, Tuomas; Antikainen, Riina; Leskinen, Pekka (2019)
    International Journal of Sustainable Development & World Ecology 26 (7): 625-634
    Small and medium-sized enterprises (SMEs) have a substantial role in the economy and job creation, but they are a remarkable source of environmental impacts. SMEs often lack skills and resources to compile environmental impact assessments; Streamlined Life Cycle Analysis (LCA) can provide efficient tools for this. An application of streamlined LCA relying heavily on database data, LCA clinic, was developed and tested on 23 SMEs in Finland. The climate change impacts were mainly caused by the production of raw materials, electricity and heating, whereas packaging and transportation were not influential. A significant amount of emissions were indirect, i.e. caused by production of raw materials. Thus, decreasing emissions from raw material production or selecting raw materials with a smaller environmental load could be a more efficient way to decrease emissions than reducing direct emissions such as those from electricity use. Lack of data in the LCA-databases was considered a challenge. An access to regionally customised datasets is important for the implementation of LCA clinics. Company feedback indicated that LCA clinics were useful in climate-friendly product design and increased environmental awareness, but did not lead to immediate actions to reduce emissions because of inadequate investment capabilities. Company managers had limited possibilities to use the results in marketing as comparative assessments would require a full LCA. Many company managers were willing to pay a fee sufficient to cover the costs of an LCA clinic, but some considered that the costs should be covered by external funding sources.
  • Sulkunen, Pekka; Berret, Sébastien; Marionneau, Virve; Nikkinen, Janne (2022)
    Background: Gambling is an important source of public revenue in many countries. Little is known about how this revenue is generated, and how it depends on product portfolios, operating costs, turnover, and the institutional contexts of the industry. Methods: A comparative analysis of income statements from 30 European gambling companies is reported. Scatter diagrams are used to describe how the surplus depends on volume, operating costs, monopoly status, and the game portfolio measured by aggregate return-to-players (RTP). Company profiles are used to interpret the results. Hypotheses: Commercialization increases aggregate return to players. This is likely to lower the surplus. Low operating costs of automated and fast games compensate for this loss. Commercial companies produce less surplus than monopolies. Results: The surplus is a linear function of the total revenue. Excluding three big companies, total volume is positively associated with the average return percentages but not proportionately with operating costs. The difference between monopolistic and market-based companies does not appear to be significant. Detailed descriptive analysis shows that the European gambling market may be facing a situation of supply saturation where further growth of gambling proceeds for good causes can no longer be accomplished.
  • Henly, Russell K.; Ellefson, Paus V. (Suomen metsätieteellinen seura, 1986)
  • Niemi, Jarkko K.; Edwards, Sandra A.; Papanastasiou, Dimitris K.; Piette, Deborah; Stygar, Anna H.; Wallenbeck, Anna; Valros, Anna (2021)
    Tail biting is an important animal welfare issue in the pig sector. Studies have identified various risk factors which can lead to biting incidents and proposed mitigation measures. This study focused on the following seven key measures which have been identified to affect the risk of tail biting lesions: improvements in straw provision, housing ventilation, genetics, stocking density, herd health, provision of point-source enrichment objects, and adoption of early warning systems. The aim of this study was to examine whether these selected measures to reduce the risk of tail biting lesions in pig fattening are cost-effective. The problem was analyzed by first summarizing the most prospective interventions, their costs and expected impacts on the prevalence of tail biting lesions, second, by using a stochastic bio-economic model to simulate the financial return per pig space unit and per pig at different levels of prevalence of tail biting lesions, and third by looking at how large a reduction in tail biting lesions would be needed at different levels of initial prevalence of lesions to cover the costs of interventions. Tail biting lesions of a severity which would require an action (medication, hospitalization of the pig or other care, or taking preventive measures) by the pig producer were considered in the model. The results provide guidance on the expected benefits and costs of the studied interventions. According to the results, if the average prevalence of tail biting lesions is at a level of 10%, the costs of this damaging behavior can be as high as euro2.3 per slaughtered pig (similar to 1.6% of carcass value). Measures which were considered the least expensive to apply, such as provision of point-source enrichment objects, or provided wider production benefits, such as improvements in ventilation and herd health, became profitable at a lower level of efficacy than measures which were considered the most expensive to apply (e.g., straw provision, increased space allowance, automated early warning systems). Measures which were considered most efficient in reducing the risk of tail biting lesions, such as straw provision, can be cost-effective in preventing tail biting, especially when the risk of tail biting is high. At lower risk levels, the provision of point-source objects and other less costly but relatively effective measures can play an important role. However, selection of measures appropriate to the individual farm problem is essential. For instance, if poor health or barren pens are causing the elevated risk of tail biting lesions, then improving health management or enriching the pens may resolve the tail biting problem cost-effectively.
  • Hyvärinen, Heini; Skyttä, Annaliina; Jernberg, Susanna; Meissner, Kristian; Kuosa, Harri; Uusitalo, Laura (Springer, 2021)
    Environmental Monitoring and Assessment 193: 400
    Global deterioration of marine ecosystems, together with increasing pressure to use them, has created a demand for new, more efficient and cost-efficient monitoring tools that enable assessing changes in the status of marine ecosystems. However, demonstrating the cost-efficiency of a monitoring method is not straightforward as there are no generally applicable guidelines. Our study provides a systematic literature mapping of methods and criteria that have been proposed or used since the year 2000 to evaluate the cost-efficiency of marine monitoring methods. We aimed to investigate these methods but discovered that examples of actual cost-efficiency assessments in literature were rare, contradicting the prevalent use of the term “cost-efficiency.” We identified five different ways to compare the cost-efficiency of a marine monitoring method: (1) the cost–benefit ratio, (2) comparative studies based on an experiment, (3) comparative studies based on a literature review, (4) comparisons with other methods based on literature, and (5) subjective comparisons with other methods based on experience or intuition. Because of the observed high frequency of insufficient cost–benefit assessments, we strongly advise that more attention is paid to the coverage of both cost and efficiency parameters when evaluating the actual cost-efficiency of novel methods. Our results emphasize the need to improve the reliability and comparability of cost-efficiency assessments. We provide guidelines for future initiatives to develop a cost-efficiency assessment framework and suggestions for more unified cost-efficiency criteria.
  • Roine, Eija; Farkkila, Niilo; Sintonen, Harri; Taari, Kimmo; Roine, Risto P.; Saarto, Tiina (2019)
    Background/Aim: This cross-sectional study estimated direct cancer-related health care, productivity and informal care costs for a six-month period for different states of breast cancer (BC). Patients and Methods: A total of 827 BC patients answered a questionnaire enquiring about informal care, work capacity, and demographic factors. Direct health care resource use and productivity costs were obtained from registries. Mutually exclusive groups were formed based on disease state and time from diagnosis: primary treatment (first six months after diagnosis), rehabilitation (>six months after diagnosis), remission (>1.5 years after diagnosis), and metastatic. Results: Mean total costs were: primary treatment (sic)22,876, rehabilitation (sic)3,456, remission (sic)1,728, and metastatic (sic)24,320. Mean direct health care costs were: primary treatment (sic)11,798, rehabilitation (sic)2,398, remission (sic)1,147, and metastatic (sic)13,923. Mean productivity costs varied between 18-39% and indirect costs (productivity and informal care costs) between 31-48% of the total costs. Conclusion: Direct medical costs were highest, but indirect costs constituted up to half of the total costs and are essential when estimating the total cost burden, as many patients are of working age.
  • Raj, R.; Bendel, S.; Reinikainen, M.; Hoppu, S.; Laitio, R.; Ala-Kokko, T.; Curtze, S.; Skrifvars, M. B. (2018)
    Background: Neurocritical illness is a growing healthcare problem with profound socioeconomic effects. We assessed differences in healthcare costs and long-term outcome for different forms of neurocritical illnesses treated in the intensive care unit (ICU). Methods: We used the prospective Finnish Intensive Care Consortium database to identify all adult patients treated for traumatic brain injury (TBI), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and acute ischemic stroke (AIS) at university hospital ICUs in Finland during 2003-2013. Outcome variables were one-year mortality and permanent disability. Total healthcare costs included the index university hospital costs, rehabilitation hospital costs and social security costs up to one year. All costs were converted to euros based on the 2013 currency rate. Results: In total 7044 patients were included (44% with TBI, 13% with ICH, 27% with SAH, 16% with AIS). In comparison to TBI, ICH was associated with the highest risk of death and permanent disability (OR 2.6, 95% CI 2.1-3.2 and OR 1.7, 95% CI 1.4-2.1), followed by AIS (OR 1.9, 95% CI 15-23 and OR 1.5, 95% CI 1.3-1.8) and SAH (OR 1.8, 95% CI 1.5-2.1 and OR 0. 8, 95% CI 0.6-0.9), after adjusting for severity of illness. SAH was associated with the highest mean total costs ((sic)51,906) followed by ICH ((sic)47,661), TBI ((sic)43,916) and AIS ((sic)39222). Cost per independent survivor was lower for TBI ((sic)58,497) and SAH ((sic)96,369) compared to AIS ((sic)104,374) and ICH ((sic)178,071). Conclusion: Neurocritical illnesses are costly and resource-demanding diseases associated with poor outcomes. Intensive care of patients with TBI or SAH more commonly result in independent survivors and is associated with lower total treatments costs compared to ICH and AIS.
  • Mustonen, Erja; Horhammer, Iiris; Absetz, Pilvikki; Patja, Kristiina; Lammintakanen, Johanna; Talja, Martti; Kuronen, Risto; Linna, Miika (2020)
    Objective To evaluate the long-term effect of telephone health coaching on health care and long-term care (LTC) costs in type 2 diabetes (T2D) and coronary artery disease (CAD) patients. Data Sources/Study Setting Randomized controlled trial (RCT) data were linked to Finnish national health and social care registries and electronic health records (EHR). Post-trial eight-year economic evaluation was conducted. Study Design A total of 1,535 patients (>= 45 years) were randomized to the intervention (n = 1034) and control groups (n = 501). The intervention group received monthly telephone health coaching for 12 months. Usual health care and LTC were provided for both groups. Principal Findings Intention-to-treat analysis showed no significant change in total health and long-term care costs (intervention effect euro1248 [3 percent relative reduction], CI -6347 to 2217) in the intervention compared to the control group. There were also no significant changes among subgroups of patients with T2D or CAD. Conclusions Health coaching had a nonsignificant effect on health care and long-term care costs in the 8-year follow-up among patients with T2D or CAD. More research is needed to study, which patient groups, at which state of the disease trajectory of T2D and cardiovascular disease, would best benefit from health coaching.
  • Kuula, Laura S. M.; Backman, Janne T.; Blom, Marja L. (2021)
    Y The aim of this study was to assess costs and health service use associated with tendon injuries after the use of fluoroquinolone antimicrobialsin Finland during 2002-2012. This retrospective observational study included data from the Finnish Pharmaceutical Insurance Pool's pharmaceutical injury claims. In total, 145 compensated claimants aged >= 18 years presenting tendon injuries after the use of fluoroquinolones (FQs) were included in the study. Outcomes of interest were the number of outpatient visits to primary, secondary, tertiary, and private healthcare services, hospital days, rehabilitation and their costs. Regression models were used to analyze the impact of patient characteristics on hospital days, as well as the relationship between patient characteristics and tendon ruptures. Direct costs of a tendon injury averaged 14,800euro and indirect costs were estimated to be 9,077euro for employed claimants. Fifty-one percent of the claimants were hospitalized, with an average duration of 21 days. Hospitalization was the costliest form of health service use with an average of 9,915euro per hospital episode. Hospital days and direct costs increased with the severity of the injury. Tendon ruptures, in particular bilateral ruptures, required substantially more hospital days and their direct costs were significantly higher than those of uncomplicated tendinitis. Concurrent use of oral corticosteroids and increasing age were associated with a higher likelihood of tendon ruptures. Although rare, FQ-related tendon injuries can result in considerable costs and health service use. Medical staff should remain vigilant when prescribing FQs, especially in groups at increased risk for tendon injuries.
  • Kuula, Laura S.M.; Backman, Janne; Blom, Marja (2022)
    The aim of this study was to estimate healthcare costs and mortality associated with serious fluoroquinolone-related adverse reactions in Finland from 2008 to 2019. Serious adverse reaction types were identified from the Finnish Pharmaceutical Insurance Pool's pharmaceutical injury claims and the Finnish Medicines Agency's Adverse Reaction Register. A decision tree model was built to predict costs and mortality associated with serious adverse drug reactions (ADR). Severe clostridioides difficile infections, severe cutaneous adverse reactions, tendon ruptures, aortic ruptures, and liver injuries were included as serious adverse drug reactions in the model. Direct healthcare costs of a serious ADR were based on the number of reimbursed fluoroquinolone prescriptions from the Social Insurance Institution of Finland's database. Sensitivity analyses were conducted to address parameter uncertainty. A total of 1 831 537 fluoroquinolone prescriptions were filled between 2008 and 2019 in Finland, with prescription numbers declining 40% in recent years. Serious ADRs associated with fluoroquinolones lead to estimated direct healthcare costs of 501 938 402 (sic), including 11 405 ADRs and 3,884 deaths between 2008 and 2019. The average mortality risk associated with the use of fluoroquinolones was 0.21%. Severe clostridioides difficile infections were the most frequent, fatal, and costly serious ADRs associated with the use of fluoroquinolones. Although fluoroquinolones continue to be generally well-tolerated antimicrobials, serious adverse reactions cause long-term impairment to patients and high healthcare costs. Therefore, the risks and benefits should be weighed carefully in antibiotic prescription policies, as well as with individual patients.
  • Vepsalainen, K.; Riikonen, P.; Lassila, R.; Arola, M.; Huttunen, P.; Lähteenmäki, P.; Mottonen, M.; Selander, T.; Martikainen, J. (2018)
    AimFor previously untreated patients (PUPs) with severe haemophilia A in Finland for the past 2 decades, the standard practice has been to start early primary prophylaxis. We evaluated the long-term clinical outcomes and costs of treatment with high-dose prophylaxis in PUPs from birth to adolescence, including immune tolerance induction (ITI). MethodsFrom the medical records of all PUPs born between June 1994 and May 2013 in Finland, we retrospectively extracted data on clinical outcomes and healthcare use. Using linear mixed models, we analysed longitudinal clinical outcome data. To analyse skewed cost data, including zero costs, we applied hurdle regression. ResultsAll 62 patients received early regular prophylaxis; totally, they have had treatment for nearly 700 patient-years. The median age of starting home treatment was 1.1years. The mean (SD) annual treatment costs (Europerkg) were 4391Euro (3852). For ages 1-3, ITI comprised over half of the costs; in other groups, prophylactic FVIII treatment dominated. With these high costs, however, clinical outcomes were desirable; median (IQR) ABR was low at 0.19 (0.07-0.46) and so was AJBR at 0.06 (0-0.24). Thirteen (21%) patients developed a clinically significant inhibitor, 10 (16%) with a high titre. All ITIs were successful. The mean costs for ITI were 383448Euro (259085). The expected ITI payback period was 1.81 (95% CI 0.62-12.12) years. ConclusionsEarly high-dose prophylaxis leads to excellent long-term clinical outcomes, and early childhood ITI therapy seems to turn cost-neutral generally already in 2years.
  • Alakoski, Anna (Helsingfors universitet, 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.
  • Leino, Hanna (Helsingin yliopisto, 2021)
    There is a common understanding of the benefits of economic evaluations supporting decision making regarding health care interventions. The aim of this master’s thesis was to understand the methods of economic evaluation in mental health services to guide upcoming economic evaluations. The research objective was to investigate and describe key elements and methods that have been used in economic evaluations in mental health interventions for adults. The objective was formed by the following research questions: 1. What methods are used in economic evaluation? 2. What perspectives are considered? 3. How are outcomes measured i.e. what specific measures are used to characterise the outcomes? 4. What cost elements are included in the cost analysis? 5. What cost measures are used? 6. Is there consideration for whether the used method is appropriate to examine the matter concerned? This thesis was conducted as a systematic literature review. The PICo method was used in the formation of the research questions and the search strategy. Two databases (Ovid MEDLINE and PsycINFO) were used. In addition, Google and Google Scholar were used, and reference search from included studies was performed. The methodological quality of the included studies was assessed using the Consensus on Health Economic Criteria checklist. After data extraction and tabulation, narrative analysis was undertaken to summarise and understand the methods and elements for economic evaluation in mental health services. Overall, the quality of the 12 included studies was good. The studies represented different types of populations and interventions in mental health services. Primarily, one intervention was compared to the other, usually against existing care. Cost-effectiveness analysis, cost-utility analysis and cost minimisation analysis were applied. Studies were conducted from societal, health care or health insurance perspectives, and some studies applied two perspectives. Generic and condition-specific patient-reported outcome measures and clinician-reported outcome measures were used alongside routine administrative data to capture change in health status and quality of life. A few different cost measures with routine administrative data were used to identify and measure service resource use and productivity losses. There was variation in what costs were included. Almost all authors stated some consideration about methods suitability, at some level. This master’s thesis collated outcome measures and cost measures utilised in the mental health service context. Moreover, some data sources regarding costs were presented to reveal information sources and demonstrate how chosen perspective determines what information is needed. This master’s thesis provides guidance on what details are needed and where to collect information to conduct an economic evaluation to support decision-making in mental health services.
  • Kampman, Johanna (Helsingfors universitet, 2016)
    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.
  • Kujala, Heini; Lahoz-Monfort, José Joaquín; Elith, Jane; Moilanen, Atte (2018)
    Decisions about land use significantly influence biodiversity globally. The field of spatial conservation prioritisation explores allocation of conservation effort, including for reserve network expansion, targeting habitat restoration, or minimising ecological impacts of development. Inevitably, the utility of such planning depends on the quantity and quality input data, including spatial information on biodiversity, threats, and cost of action. In this work we systematically develop understanding about the significance of these different data types in spatial conservation prioritisation. We clarify the common ways different data types enter an analysis, develop mathematical models to understand the effects of data in spatial prioritisation, and survey literature to establish typical quantities of different types of data used. We use Jackknife analysis to derive the expected change in site values, when a single new data layer is added to a prioritisation. We validate mathematical formulae for expected impacts using simulations. A survey of scientific literature reveals that typical spatial prioritisation analyses include hundreds of biodiversity feature layers (species, habitat types, ecosystem services), but the count of cost, threat or habitat condition layers is typically 0-5. Due to these differences, and the mathematical formulations commonly used to combine data types, the influence of a single cost, threat, or habitat condition data layer can be an order or two higher than the influence of a single biodiversity feature layer. In a classical cost-effectiveness formulation (benefits divided by costs, B/C) the influence of a single cost layer can even be as large as the joint influence of thousands of species distributions. We also clarify how changes in data impact site values and spatial priority rankings differently, with the latter being further influenced by data correlations, the spread of numeric values inside data layers and other data characteristics. For example, costs influence priorities significantly if cost is positively correlated with biodiversity, but the correlation is the other way around for biodiversity and habitat condition. This work helps conservation practitioners to direct efforts when collating data for spatial conservation planning. It also helps decision makers understand where to focus attention when interpreting conservation plans and their uncertainties.
  • Koskinen, Hanna (Kela, 2018)
    Studies in social security and health 150
    This study examines the impact of the implementation of a generic reference price system on pharmaceutical prices and competition within the market. The focus is particularly on antipsychotic medications. Furthermore, the impact of reference pricing on previously implemented generic substitution is assessed. Antipsychotics and antidepressants were, in terms of value, among the fastest growing pharmaceutical groups in Finland at the turn of the 21st century. For antipsychotics, most of the cost growth resulted from the rise in the mean daily cost of treatment, whereas the main reason for antidepressant cost growth was the increased number of patients. The implementation of reference pricing decreased the daily cost of the studied antipsychotics. The decreases ranged from 30% to 66% in the short term and from 25% to 51% in the medium-to-long term. When the study was extended to other pharmaceutical groups, the average decrease was 35% at the end of the first year, 56% at the end of the second year and 60% at the end of the third year. However, there were large differences in the size of the decrease between groups. Being included in the reference price system had the largest decreasing impact on prices. However, the reference price system’s impact on prices appeared to be waning; the later an active substance was included in the system, the higher the price level remained. In addition, the impact of the reference price system on previously implemented generic substitution remained low, and 2.5 years after the implementation of the reference price system it was almost non-existent. Generic pharmaceutical markets are highly concentrated in Finland. In addition, there is an overall lack of transparency in the pharmaceutical distribution chain. Further research is needed on the barriers of entry and on the role different operators of the pharmaceutical distribution chain have in promoting price competition in the generic market sector.
  • Almeida, Diana Abondano; Mappes, Johanna; Gordon, Swanne (2021)
    Predator-induced plasticity in life-history and antipredator traits during the larval period has been extensively studied in organisms with complex life-histories. However, it is unclear whether different levels of predation could induce warning signals in aposematic organisms. Here, we investigated whether predator-simulated handling affects warning coloration and life-history traits in the aposematic wood tiger moth larva, Arctia plantaginis. As juveniles, a larger orange patch on an otherwise black body signifies a more efficient warning signal against predators but this comes at the costs of conspicuousness and thermoregulation. Given this, one would expect that an increase in predation risk would induce flexible expression of the orange patch. Prior research in this system points to plastic effects being important as a response to environmental changes for life history traits, but we had yet to assess whether this was the case for predation risk, a key driver of this species evolution. Using a full-sib rearing design, in which individuals were reared in the presence and absence of a non-lethal simulated bird attack, we evaluated flexible responses of warning signal size (number of orange segments), growth, molting events, and development time in wood tiger moths. All measured traits except development time showed a significant response to predation. Larvae from the predation treatment developed a more melanized warning signal (smaller orange patch), reached a smaller body size, and molted more often. Our results suggest plasticity is indeed important in aposematic organisms, but in this case may be complicated by the trade-off between costly pigmentation and other life-history traits.
  • Eronen, Jarmo (Suomen metsätieteellinen seura, 1982)
  • Gazzola, Michele; Grin, François; Häggman, Johan; Moring, Tom Arne (2016)
    The EU professes to have a positive policy towards RMLs, as enshrined in Article 22 of the European Charter of Fundamental Rights. Since the beginning of the 1980s the then European Economic Community has shown some awareness of the issue and has tried to support RMLs in a variety of ways. This support, nevertheless, has decreased over time, in particular since 2000. The goal of this article is to provide a detailed financial assessment of EU support to RMLs from 1994 to 2006 and to present the main trend in RMLs support after 2006. This article, based on official data, shows that the amounts concerned, even during the relatively more favourable 1990s, have remained small. We also conclude that RML-specific programmes and actions (as opposed to mainstreaming support) have been much more successful at channelling resources towards RMLs. We conclude the article by discussing the most important trends in RML support after 2006, showing that supportfrom the EU in this area has remained modest.