Tiina Leivo

Cost-utility of routine cataract surgery.

BackgroundIf decisions on health care spending are to be as rational and objective as possible, knowledge on cost-effectiveness of routine care is essential. Our aim, therefore, was to evaluate the cost-utility of routine cataract surgery in a real-world setting.MethodsProspective assessment of health-related quality of life (HRQoL) of patients undergoing cataract surgery. 219 patients (mean (SD) age 71 (11) years) entering cataract surgery (in 87 only first eye operated, in 73 both eyes operated, in 59 first eye had been operated earlier) filled in the 15D HRQoL questionnaire before and six months after operation. Direct hospital costs were obtained from a clinical patient administration database and cost-utility analysis performed from the perspective of the secondary care provider extrapolating benefits of surgery to the remaining statistical life-expectancy of the patients.ResultsMean (SD) utility score (on a 0–1 scale) increased statistically insignificantly from 0.82 (0.13) to 0.83 (0.14). Of the 15 dimensions of the HRQoL instrument, only seeing improved significantly after operation. Mean utility score improved statistically significantly only in patients reporting significant or major preoperative seeing problems. Of the subgroups, only those whose both eyes were operated during follow-up showed a statistically significant (p < 0.001) improvement. Cost per quality-adjusted life year (QALY) gained was €5128 for patients whose both eyes were operated and €8212 for patients with only one eye operated during the 6-month follow-up. In patients whose first eye had been operated earlier mean HRQoL deteriorated after surgery precluding the establishment of the cost per QALY.ConclusionMean utility gain after routine cataract surgery in a real-world setting was relatively small and confined mostly to patients whose both eyes were operated. The cost of cataract surgery per quality-adjusted life year gained was much higher than previously reported and associated with considerable uncertainty.

The cost-effectiveness of nationwide breast carcinoma screening in Finland, 1987–1992

The aim of this study was to evaluate the cost‐effectiveness, from a societal perspective, of the Finnish nationwide breast carcinoma screening program.

Incremental cost‐effectiveness of double‐reading mammograms

Background. Double reading is a widely used criterion standard in breast cancer screening despite a lack of evidence of the cost‐effectiveness of the second reading. This study evaluates the incremental cost‐effectiveness of such a strategy.Design. Cost‐effectiveness analysis: Nationwide population‐based semi‐annual screening program for women aged 50–59 in Finland. Participation rate was 91%. All mammograms (95,423) performed during 1990–1995 in three screening centers of the Finnish Cancer Society were read by two radiologists with gradings recorded. The effectiveness of the double reading was the difference in cancers detected in the double compared to that of the single reading. Incremental costs of the double reading for the health care and non‐health care and the time costs were estimated. The main outcome measure was the incremental cost per additional cancer found as a result of the double‐reading strategy.Results. The total number of cancers detected with the double and single reading were 290 and 261, respectively. A significantly higher ratio of carcinoma in situ was the causative pathology in cancers detected only by the second reader. The cost per cancer detected with a single reading was US

Sports-related eye injuries: the current picture

18,340. The incremental cost of any additional cancer found was US

Ocular traumas in working age adults in Finland - Helsinki Ocular Trauma Study

25,523, that is, a 39% higher cost per additional cancer found by double reading.Conclusions. The additional cost per cancer detected by double reading is not drastically higher than with single reading. However, the additional cost per life year saved may be much higher.

Paediatric eye injuries in Finland – Helsinki eye trauma study

This study aims to represent the epidemiologies, findings, treatments, use of resources, outcomes and protective‐eyewear‐use recommendations in sports‐related eye injuries by sport type.

IgG4-related disease mimicking chalazion in the upper eyelid with skin manifestations on the trunk

To describe epidemiology, causes, treatments and outcomes of ocular injuries in adults aged 17 to 60 in southern Finland.

Airbag deployment–related eye injuries

To determine the current population‐based epidemiology, treatment, use of resources and outcomes of childrens eye injuries in Finland.

Costbenefit analysis of Helicobacter pylori screening

IgG4-related disease is a recently defined inflammatory process characterized by IgG4-bearing plasma cells in the involved tissues. The most common sites of involvement are the pancreas, hepatobiliary tract, salivary glands, lymph nodes, retroperitoneum and orbit, especially the lacrimal glands. Other ocular or ocular adnexal sites are rare. To our knowledge, there is one reported case of a conjunctival involvement. We describe a patient, who had an IgG4-RD mimicking chalazion in the upper eyelid, confined to the tarsus, with multiple skin lesions on the trunk. This is a case report of a 55-year-old female. A 55-year-old female presented with an upper eyelid lesion, which was clinically diagnosed as chalazion and drained three times. Histopathological diagnoses were chalazion and inflammation with mixed cells, respectively. Additionally, the patient had had skin nodules on the trunk for several years. Finally, after a third recurrence, the tarsal eyelid lesion was completely excised. The tarsal pathology specimen showed 85 IgG4 positive plasma cells per HPF and the IgG4/IgG ratio was 0.64, suggesting a probable IgG4-related disease. The re-examined skin lesions resembled histologically the eyelid lesion. It is essential to be aware of IgG4-related disease, including in recurrent chalazia.

Ocular traumas in the Finnish elderly- Helsinki Ocular Trauma (HOT) Study

ABSTRACT Objective: We studied the correlation between airbag deployment and eye injuries using 2 different data sets. Methods: The registry of the Finnish Road Accident (FRA) Investigation Teams was analyzed to study severe head- and eyewear-related injuries. All fatal passenger car or van accidents that occurred during the years 2009–2012 (4 years) were included (n = 734). Cases in which the drivers front airbag was deployed were subjected to analysis (n = 409). To determine the proportion of minor, potentially airbag-related eye injuries, the results were compared to the data for all new eye injury patients (n = 1,151) recorded at the Emergency Clinic of the Helsinki University Eye Hospital (HUEH) during one year, from May 1, 2011, to April 30, 2012. Results: In the FRA data set, the unbelted drivers showed a significantly higher risk of death (odds ratio [OR] = 5.89, 95% confidence interval [CI], 3.33–10.9, P = 2.6E-12) or of sustaining head injuries (OR = 2.50, 95% CI, 1.59–3.97, P = 3.8E-5). Only 4 of the 1,151 HUEH patients were involved in a passenger car accident. In one of the crashes, the airbag operated, and the belted driver received 2 sutured eye lid wounds and showed conjunctival sugillation. No permanent eye injuries were recorded during the follow-up. The calculated annual airbag-related eye injury incidence was less than 1/1,000,000 people, 4/100,000 accidents, and 4/10,000 injured occupants. Conclusions: Airbag-related eye injuries occurred very rarely in car accidents in cases where the occupant survived and the restraint system was appropriately used. Spectacle use did not appear to increase the risk of eye injury in restrained occupants.