Browsing by Subject "nivelreuma"

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  • Joensuu, Jaana (Helsingfors universitet, 2013)
    Rheumatoid arthritis (RA) is a chronic autoimmune disease with prevalence of 0.8% among Finnish adult population. Consequent medical treatment, joint replacement surgery and productivity losses lead to significant expenses for society. While biological treatments for RA are costly, they can improve patients' quality of life and work participation. Economic evaluations provide information on the benefits and costs of these expensive treatments to aid optimal utilization of limited healthcare resources. This master`s thesis comprises the description of the Finnish Current Care Guidelines for RA, the cost of biological treatments and the principles of economic evaluations and health technology assessment. A systematic literature review was performed to identify existing studies examining the cost-effectiveness of biological treatments for RA. Of the 4890 references found with the literature search, 38 original studies and 9 previous systematic reviews were included in the current systematic literature review. Details of the methods as well as information on treatments, costs, benefits and incremental cost-effectiveness were extracted. Quality of the original studies was evaluated using quality assessment tools. Ninety percent (34/38) of the original studies used cost-utility modeling approach. Quality of life estimates were derived from RA specific health assessment questionnaire in a majority of the studies. Based on the current systematic literature review, the evidence on the cost-effectiveness of biological treatments is inconsistent. The incremental cost-effectiveness of the tumor necrosis factor (TNF) blockers was 13 500-772 000 €/ quality adjusted life year (QALY) in comparison to conventional disease modifying anti rheumatic drugs (DMARD) among patients without previous treatment with DMARDs. Several studies reported incremental cost-effectiveness ratios over 100 000 €/QALY in this population. Among patients with insufficient response to DMARDs, TNF blockers provided incremental cost-effectiveness ratios between 6 700 and 317 000 €/QALY. In most studies Rituximab was found to be a cost-effective alternative in contrast to other treatments among patients with insufficient response to TNF blockers. Biological treatments are not cost-effective among patients naïve to conventional DMARDs. Meanwhile, in patients with previous DMARD failure TNF-blockers might be cost-effective. The evidence on the cost effectiveness of biological treatments supports Finnish Current Care Guidelines. The quality assessment of the included studies revealed several sources of bias, consequently reducing the validity of the studies. Only a few of the conference abstracts in current subject has been published later as an article indicating existence of reporting bias. This study has several strengths. First, a comprehensive literature search was performed. Second, the quality of included studies was carefully evaluated. Finally, the methods and reporting are transparent. Weakness of the current study is one person extracting data and assessing the quality of the studies, which may reduce the reliability of this study. This systematic literature review is a basis for future studies examining cost-effectiveness of biological treatments in Finnish healthcare system.
  • Aaltonen, Kalle (Helsingfors universitet, 2010)
    Rheumatoid arthritis is an inflammatory autoimmune disease with prevalence of 0,8 per cent of Finnish people. Rheumatoid arthritis may lead to immobility and premature death. Treatment of Rheumatoid Arthritis includes disease modifying anti-rheumatic drugs and surgery. TNF-blockers are efficacious new drugs, which halt the progression of joint destruction caused by inflammation. The first TNF-blocker to receive permission of the national agency for medicines was Infliximab in 1999. Since then Infliximab has been followed by Etanercept, Adalimumab, Golimumab and Certolizumab. TNF-blockers have been found to be more efficacious than placebo in both clinical trials and register studies. In addition they are considered to be safe enough for clinical use despite the increased risk for tuberculosis and certain cancers. The number of patients annually treated with TNF-blockers in Finland increased threefold between 2004 and 2008. In 2008 the medication costs per patient were 11 669€ for Etanercept and 13 074€ for adalimumab. Systematic literature review is a study, which searches, identifies and combines individual studies. Usually Systematic reviews include a meta-analysis, which uses statistical methods to combine the results of the studies. Meta-analysis aims for increasing power and generalisibility of the studies and reducing the potential bias in individual studies. In order not to introduce bias by itself the systematic review must be done following the methods approved by the scientific community. In addition the process must be documented in detail. Following a predefined search strategy the systematic literature search found 5308 references. After a process involving the evaluation of the patients, intervention, control, outcomes, study design and the risk of bias 27 studies were selected to be included in the systematic review and meta-analysis. Of the included studies, nine had adalimumab, six had etanercept, five had infliximab, four had golimumab and three certolizumab as intervention. TNF-blocker was used either alone or in combination with methotrexate whereas control was either placebo or methotrexate. Altogether, there were 11 533 patients in the intervention group and 9027 in the control group. The results of the meta-analysis indicate reveal that the patients treated with TNF-blockers are twice as likely to reach a 20 % increase on ACR criteria compared to control patients. The likelihood to reach improvements of 50 and 70 % was 3 and 3.5 times higher, respectively. There were no statistically significant differences in efficacy between individual TNFblockers. Increasing the dosage of a TNF-blocker did not increase efficacy. However, combination of TNF-blocker and methotrexate was superior to monotreatment of TNF-blocker without increasing the likelihood of discontinuation of treatment. There were no statistically significant differences between the efficacy of TNF-blocker monotherapy and methotrexate. Adalimumab, infliximab and certolizumab lead more often to treatment discontinuation compared to etanercept and golimumab, which do not differ from control. This systematic review probably found all studies that investigated the efficacy of TNF-blockers in a randomized controlled trial. Study selection and evaluation were based on widely accepted methods. This study has two weaknesses. Firstly, literature search and study selection and evaluation were done only by a single researcher. Secondly, unpublished studies and study results were not actively obtained outside electronic databases.
  • Alfat, Bamo (Helsingin yliopisto, 2019)
    Parodontiitti eli hampaiden tuki- ja kiinnityskudossairaus ja nivelreuma ovat molemmat kroonisia tulehdussairauksia, joiden patologiset taudinkulut muistuttavat vahvasti toisiaan. Tämän tutkielman tarkoituksena oli selvittää, kuinka nivelreuman hoitoon käytetyt biologiset lääkeainehoidot tehoavat samanaikaisesti potilaiden parodontiumiin ja mahdollisesti biofilmi välitteiseen parodontiittiin. Uudet spesifisesti vaikuttavat monoklonaalliset vasta-aineet ovat tuoneet moderniin lääketieteeseen tehokkaat ja tarkasti toimivat tavat hoitaa potilaiden monimuotoisia sairauksia. Nivelreuman sekä parodontiitin samantapaiset patogeeniset, etiologiat, yhteiskunnallisesti kalliit hoidot ja sairauksien vahvat yhteydet toisiinsa ovat isoja tekijöitä sille, miksi sairauksien yhtaikaista lääkehoitamista olisi syytä tutkia. Proinflammatoriset TNF-alfa-, IL-6- ja IL-1-sytokiinit ovat todistetusti osoittaneet isot roolinsa molempien tulehduksellisten sairauksien patologisissa prosesseissa. Täten esille nouseekin kysymys, että kuinka systeemisesti toteutetut biologiset lääkehoidot vastaavat sairauksien hoitoon. Lääkehoitojen kalliiden kulujen takia olisi järkevää ja yhteiskunnallisesti kannattavaa hyödyntää kyseisiä lääkeainehoitoja tehokkaan kohdistetusti sellaisille potilasryhmille, jotka hyötyisivät niistä kaikkein eniten. Näin potilaiden hoitomyöntyvyydet pitkille sekä raskaille hoidoille lisääntyisivät sekä tautien komplikaatioriskit vähentyisivät. Kaiken kaikkiaan pitkittäisprospektiiviset potilastutkimukset osoittivat tilastollisesti merkittäviä parannuksia nivelreumapotilaiden reumatologisissa - sekä parodontaallisissa parametreissa. Lääkeainehoidot osoittivat tehonsa nopeasti ja olivat muihin immunosuppressiivisiin lääkehoitoihin verrattuna tehokkaampia sekä paremmin siedettyjä. Täten biologiset lääkehoidot voisivat mahdollisesti tulevaisuudessa toimia osana parodontiitin hoitoa. Positiivisista tuloksista huolimatta on kuitenkin hyvä sanoa, että mittavampia tutkimuksia aiheesta tarvitaan lisää.
  • 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.
  • Partinen, Eija (2005)
    Tutkimuksen tarkoituksena on ollut selvittää, miten yksittäiset kokemukset, jotka liittyvät nivelreumaa sairastavan ihmisen sairauteen, konstruoituvat yksilön suhteeksi hänen sairauteensa elämänkulun aikana ja millaisina sairautta ja sairauden kokemista koskevat aiemmat havainnot tulevat esille heijastettaessa niitä nivelreumaan? Haastattelin tutkielmaa varten kahtatoista 20–76 -vuotiasta, itä- ja kaakkoissuomalaista miestä ja naista. Heistä kaikki sairastivat nivelreumaa. Ongelmien asettamisessa johtoajatuksenani on ollut nivelreuman kokemisen moniselitteisyyden läpinäkyvämmäksi tekeminen sairautta ja sairauden kokemista koskevien käsitysten avulla kulttuurihistoriallisen toiminnan teorian viitekehyksessä. Hyödyntämieni tutkimusmenetelmien käytön tarkoituksena on ollut tulkita haastateltavien omia tulkintoja sairauden kokemisesta sekä tulkita haastattelijana näiden käsitysten välityksellä niiden yhteiskunnallista jäsentyneisyyttä. Laadullinen tutkimusote, jossa ihmisten toimintaa tarkastellaan heidän konteksteistaan käsin, on ollut tarpeellinen selvittäessäni nivelreuman merkitystä haastateltavien elämässä. Tulosteni mukaan, tarkastellessani sairautta aiempien suomalaisten ja ulkomaisten tutkimusten sekä haastattelupuheiden pohjalta, tuli esille se, että nykyinen kulttuurinen ajattelu on alkanut suosia kokijan näkökulmaa sairauteen uudenlaisen ruumistietoisuuden synnyn myötä. Nivelreuman kokeminen ruumiillisena sairautena näytti olevan myös sidoksissa tuohon kehitykseen. Tulosteni mukaan suhde nivelreumaan ja sen konkreettisiin, ruumiillisiin muutoksiin kehittyy elämänkulun pituisena vuosien myötä. Keskeisin tulokseni oli se, että suhteen muodostumisessa nivelreumaan olisi näin ollen kysymys vuorovaikutuksen rakentumisesta omaan ruumiiseen. Nivelreumaan sopeutuminen nosti esille tuloksissani sosiaalisen, emotionaalisen ja ruumiillisen tuen merkitykset. Sekä oman perheen että muiden nivelreumaa sairastavien tuki oli haastateltaville tärkeätä myönteisen sairauteen suhtautumisen kannalta. Tärkeinä lähteinäni ovat olleet Michael Buryn (1997; 1998) terveyssosiologiset esseet, Peter Conradin (2004) ajankohtaiset, kriittiset näkökulmat sairauteen ja sairauden kokemiseen, Ullamaija Seppälän (1998) väitöskirja elämästä pitkäaikaisen sairauden kanssa ja Ritva Engeströmin (1999) tutkimus lääkärinvastaanottojen keskusteluista piirtämässä kuvaa kulttuurihistoriallisesta toiminnan teoriasta. Myös monet muut artikkelit (esim. Peräkylä 2000; Helén 2000) ovat täsmentäneet ajatteluani sairaudesta ja sairauden kokemisesta.