Terhi Kurko

Is nicotine replacement therapy overvalued in smoking cessation? Analysis of smokers' and quitters' communication in social media.

Internet discussion forums provide new, albeit less used data sources for exploring personal experiences of illness and treatment strategies.

Is pharmaceutical policy evidence-informed? A case of the deregulation process of nicotine replacement therapy products in Finland

OBJECTIVE This qualitative study aims to identify the key dimensions of the political argumentation in the debate leading up to the deregulation of nicotine replacement therapy products (NRT) in Finland in 2006. The deregulation was introduced by the Amendment of larger package of changes in medical legislation prepared in 2005. METHODS All publicly available documents of the legislative process introducing NRT deregulation and interviews of 12 Members of Finnish Parliament conducted in spring 2006 were analyzed by inductive content analysis. RESULTS NRT deregulation was introduced to decision-makers as a safe intervention to increase smoking cessation and thus provide public health benefits. However, a whole variety of other features were brought into debate: NRT characteristics, principle change in prevailing medical legislation, use of evidence and the political process. Finally, the expected public health benefits of the decision were not directly informed by any evidence. CONCLUSIONS This study provides an example of the use of public health benefits as justification for decision-making. However, the decision can include other aspects, less brought up in its preparation stage. Our study addresses the need for policymakers to critically evaluate the evidence, its suitability in decision-making context and raise awareness of the principles of evidence-informed policy-making.

Growth of diabetes drug expenditure decomposed—A nationwide analysis

OBJECTIVES The aim of this study was to quantify different factors underlying the growth of diabetes drug expenditure in Finland. METHODS Data representing purchases of antidiabetic agents between 2003 and 2015 were extracted from a nationwide prescription register. By using Fishers Ideal Indexes, the per capita expenditure growth for both insulins and non-insulin antidiabetic agents was decomposed into six different determinants: purchase volume, purchase size, switches between therapeutic classes, switches within therapeutic classes, unit costs and switches to generic alternatives. RESULTS Between 2003 and 2015, the per capita expenditure on insulins increased by €8.64 and on non-insulins by €13.73. For insulins, holding other factors constant, change in the number of purchases represented a €4.67 increase in expenditure, change in the size of purchases a €4.33 increase and switches between therapeutic classes a €4.07 increase. For non-insulins, change in the number of purchases represented a €10.22 increase in expenditure and switches between therapeutic classes, a €10.17 increase. Changes in purchase size increased the non-insulin per capita expenditure by €1.48. For both insulins and non-insulins, changes in prices and product level switches had decreasing effects on expenditures. CONCLUSIONS The main drivers of the growth in diabetes drug expenditure were volume growth and switches to newer and more expensive drugs. Price changes, however, had a decreasing effect on the overall diabetes drug expenditure.