Hungarian National Health Insurance Fund Research Articles

Positive correlation between persistence of medical nutrition therapy and overall survival in patients with head and neck cancer.

Background: Several factors can affect overall survival of head and neck cancer (HNC) patients, including characteristics of the cancer disease and response to treatments. However, patients' nutritional status and the effectiveness of medical nutrition therapy (MNT) can also impact overall survival. The primary goal of our research was to collect real-life data on the use of MNT in HNC patients and to specifically investigate the correlation between survival and the duration of uninterrupted (persistent) nutrition. Method: The data of this retrospective, analytical, cohort study was collected from electronic healthcare records from the Hungarian National Health Insurance Fund Management. Overall, 38,675 HNC patients' data of the period between 2012 and 2021 was used. We applied multi-step exclusions to identify patient groups accurately and to avoid biasing factors. Statistical analysis was done by the Kaplan-Meier method, log-rank test, and Cox regression analysis. Results: Throughout the investigated period 16,871 (64%) patients received MNT therapy out of 26,253 newly diagnosed patients (≥18years). In terms of the persistence of MNT, we divided the patients into three groups (1-3; 4-6; ≥7-month duration of MNT). When comparing these groups, we found that patients receiving long-term (≥7months) MNT had a significantly longer overall survival (p < 0.0001) than those who received MNT for a shorter duration, both in locally advanced and recurrent/metastatic cases. Conclusion: The main outcome of the study is that there is a positive correlation between the persistence of MNT and the overall survival in HNC patients when nutritional intervention lasts several months. It highlights the responsibility of the specialists during the patient journey to use MNT early and to continue its use for as long as it is beneficial to the patients.

Significant changes in advanced lung cancer survival during the past decade in Hungary: impact of modern immunotherapy and the COVID-19 pandemic.

The approval of immunotherapy (I-O) for the treatment of late-stage non-small cell lung cancer (NSCLC) opened new perspectives in improving survival outcomes. However, survival data have not yet been provided from the period of the Covid-19 pandemic. The aims of our study were to assess and compare survival outcomes of patients with advanced LC receiving systemic anticancer treatment (SACT) before and after the approval of immunotherapy in Hungary, and to examine the impact of pandemic on survival outcomes using data from the Hungarian National Health Insurance Fund (NHIF) database. This retrospective, longitudinal study included patients aged ≥20 years who were diagnosed with advanced stage lung cancer (LC) (ICD-10 C34) between 1 January 2011 and 31 December 2021 and received SACT treatment without LC-related surgery. Survival rates were evaluated by year of diagnosis, sex, age, and LC histology. In total, 35,416 patients were newly diagnosed with advanced LC and received SACT during the study period (mean age at diagnosis: 62.1-66.3 years). In patients with non-squamous cell carcinoma, 3-year survival was significantly higher among those diagnosed in 2019 vs. 2011-2012 (28.7% [95% CI: 26.4%-30.9%] vs. 14.45% [95% CI: 13.21%-15.69%], respectively). In patients with squamous cell carcinoma, 3-year survival rates were 22.3% (95% CI: 19.4%-25.2%) and 13.37% (95% CI: 11.8%-15.0%) in 2019 and 2011-2012, respectively, the change was statistically significant. Compared to 2011-2012, the hazard ratio of survival change for non-squamous cell carcinoma patients was 0.91, 0.82, and 0.62 in 2015-2016, 2017-2018, and 2019, respectively (p<0.001 for all cases). In the squamous cell carcinoma group, corresponding hazard ratios were 0.93, 0.87, and 0.78, respectively (p<0.001 for all cases). Survival improvements remained significant in both patient populations during the Covid-19 pandemic (2020-2021). No significant improvements were found in the survival of patients with small cell carcinoma. Platinum-based chemotherapy was the most common first-line treatment in all diagnostic periods, however, the proportion of patients receiving first- or second-line immunotherapy significantly increased during the study period. 3-year survival rates of NSCLC almost doubled among patients with non-squamous cell carcinoma and significantly improved at squamous cell carcinoma over the past decade in Hungary. Improvements could potentially be attributable by the introduction of immunotherapy and were not offset by the Covid-19 pandemic.

Incremental cost of premature birth – a public health care payer perspective from Hungary

BackgroundPreterm birth remains a significant burden to families, health systems and societies. The aim was to quantify the incremental prematurity-related public health expenditure in Hungary and to estimate the potential impact of a decrease in the prevalence of prematurity on the public payer’s spending.MethodsOver a 6-year time horizon, public financing data of inpatient, outpatient and pharmaceutical care for children born at ≥ 25 weeks of gestation in 2009/2010 were retrieved from the Hungarian National Health Insurance Fund database. In descriptive analysis, the public payer’s spending was given as cost/capita. The impact of a decrease in prematurity prevalence was specified as the total budget impact. An exchange rate of 294 Hungarian forint/Euro was applied.ResultsA total of 93,124 children (including 8.6% who were premature babies) were included in the analysis. A strong negative relationship was shown between gestational age and per capita cost. The 6-year cost of care for the cohort born at 26 weeks of gestation (28,470 Euro per capita) was 24 times higher than that for the cohort born at 40 weeks. First-year inpatient spending accounted for the largest proportion of total health care spending across all gestational ages. All investigated prematurity complications (retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, intraventricular cerebral bleeding and leukomalacia) resulted in additional significant incremental spending. If 70% of pregnancies ending with preterm birth could be prolonged by 1 week, the savings would be almost 7.0 million Euros in the first 6 years of life.ConclusionThis comprehensive analysis of prematurity-related health care spending confirmed that premature infants have much higher costs for care than those born at term in Hungary. These quantitative outcomes can provide essential inputs for the cost-effectiveness analysis of medical technologies and public health interventions that can decrease the prevalence of premature birth.Trial registrationNot applicable.

Prevalence and Annual Health Insurance Cost of Endometriosis in Hungary-A Nationwide Study Based on Routinely Collected, Real-World Health Insurance Claims Data.

Endometriosis is a disease that is often diagnosed late and that may lead to significant reduction in quality of life and serious complications (e.g., infertility). We aimed to assess the prevalence and the annual, nationwide health insurance treatment cost of endometriosis in Hungary using a quantitative, descriptive, cross-sectional method, focusing on the year 2019. We used claims data obtained from the Hungarian National Health Insurance Fund Administration (NHIFA). Patient numbers, total and age-specific prevalence, annual health insurance expenditure, and the distribution of costs across age groups were determined. The NHIFA spent a total of HUF 619.95 million (EUR 1.91 million) on endometriosis treatment. The highest number of patients and prevalence (10,058 women, 197.3 per 100,000) were found in outpatient care. In acute inpatient care, prevalence was substantially lower (23.5 per 100,000). Endometriosis, regardless of its type, affects 30-39-year-olds in the highest number: 4397 women (694.96 per 100,000) in this age group were affected in 2019. The average annual health insurance expenditure per capita was EUR 189.45. In addition to early detection and diagnosis of endometriosis, it is of pivotal importance to provide adequate therapy to reduce costs and reduce the burden on the care system.

The long-term effect of generic price competition on the Hungarian statin market

BackgroundGeneric competition is a vital health policy tool used in regulating the pharmaceutical market. Drug group HMG-CoA reductase (3-hydroxy-3-methyl-glutaryl-coenzyme-A reductase) inhibitors, widely known as “statins,” was the first drug group in Hungary in which generic prescriptions became mandatory. Our aim is to analyze the changes in the retail and wholesale margins through the generic competition regarding “statins”.MethodsData was derived from the nationwide pharmaceutical database of the Hungarian National Health Insurance Fund Administration, the only health care financing agency in Hungary. We observed the turnover data regarding the HMG-CoA-reductase inhibitor “statins” from 2010 through 2019. As the drugs under review have a fixed price point in Hungary, we effectively calculated the margins.ResultsIn 2010, the consumer expenditure of statins was 30.7 billion HUF ($148 million), which decreased by 59%, to 12.5 billion HUF ($42.9 million) in 2019. In 2010, the annual health insurance reimbursement of statins was 23.7 billion HUF ($114 million), which underwent a 63% decrease to 8.6 billion HUF ($29.7 million) in 2019. In 2010, the DOT turnover was 287 million days, and it increased to above 346 million days for 2019, which reflects a 20% increase over the past nine years. The monthly retail margins decreased from 334 million HUF ($1.6 million), (January, 2010) to 176 million HUF ($0.61 million), (December, 2019). The monthly wholesale margins decreased from 96.3 million HUF ($0.46 million), (January, 2010) to 41.4 million HUF ($0.14 million), (December, 2019). The most significant downturn in margins was due to the introduction of the first two blind bids. The combined DOT turnover in reference to the examined 43 products consistently increased.ConclusionsThe decline in retail and wholesale margin and in health insurance expenditures was largely due to a reduction in the consumer price of generic medicines. DOT turnover of statins also increased significantly.

Mortality on DOACs Versus on Vitamin K Antagonists in Atrial Fibrillation: Analysis of the Hungarian Health Insurance Fund Database

Limited real-world data are available on the survival of patients treated with vitamin K antagonists (VKAs) versus with direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (AF). In this nationwide registry, we analyzed the mortality risk of patients with nonvalvular AF taking DOACs versus VKAs, with a special attention to the early treatment period. The Hungarian National Health Insurance Fund (NHIF) database was searched to identify patients treated with VKA or DOAC as a thromboembolic prophylaxis for nonvalvular AF between 2011 and 2016. The overall and the early (0-3, 4-6, and 7-12 months) mortality risks with the 2 types of anticoagulation were compared. A total of 144,394 patients with AF treated with either a VKA (n=129,925) or a DOAC (n=14,469) were enrolled. A 28% improvement in 3-year survival with DOAC treatment compared with VKA treatment was shown. Mortality reduction with DOACs was consistent across different subgroups. However, younger patients (30-59 years old) initiated on DOAC therapy had the greatest RRR (53%) in mortality. Furthermore, DOAC treatment also yielded a benefit of greater magnitude (HR = 0.55; 95% CI, 0.40-0.77, P = 0.001) in the lower (0-1) CHA2DS2-VASc score segment and in those with fewer (0-1) bleeding risk factors (HR = 0.50, CI 0.34-0.73, P = 0.001). The RRR in mortality with DOACs was 33% within the first 3 months, and 6% in the second year. Thromboembolic prophylaxis with DOACs in this study yielded significantly lower mortality compared with VKA treatment in patients with nonvalvular AF. The largest benefit was shown in the early period after treatment initiation, as well as in younger patients, those with a lower CHA2DS2-VASc score, and those with fewer bleeding risk factors.

Association of exogenous factors with the access to innovative pharmaceutical products in Hungary.

Access to innovative pharmaceuticals is thought to be associated with several exogenous factors related to the local legal or financial framework of pharmaceutical reimbursement. Our aim was to describe the association between the outcome of the reimbursement procedure on innovative pharmaceutical submissions in Hungary and several potential explanatory variables related to the legal or financial framework of reimbursement procedures, such as the submission implying a need for a legal act to conclude on a positive decision; having a risk-sharing agreement (RSA) in place at the time of submission; the aim of the submission and expenditure on individual funding requests. Publicly available administrative announcements of the Hungarian National Health Insurance Fund Manager were used to construct the analysis dataset including all concluded procedures between 1 January 2018 and 7 June 2021, complemented with information on the overall aim of the submission (new compound or new indication). Logistic regression models were used to estimate odds ratios while adjusting for potential confounding. Needing a legislative change as a proxy of involving high-level decision makers to reimburse had a lower (OR = 0.05, CI95%:0.02-0.11), whereas having an RSA had a statistically significant higher chance of a positive decision (OR = 3.49, CI95%:1.56-7.82). In contrast, neither the overall purpose of the submission (OR = 1.32, CI95%:0.65-2.69), nor the average biennial expenditure on individual funding requests exceeding 200 million HUFs (OR = 1.04, CI95%:0.92-1.19) had a statistically significant association with the decision. This study quantitatively demonstrated that the need for legal acts to conclude on a positive decision decreases, whereas having an RSA for the particular product increases the likelihood of a positive reimbursement decision in Hungary. The role of other factors remain unclear. Our findings suggest that the legal requirements and RSAs play key roles in the reimbursement of innovative pharmaceuticals and can be viewed as potential areas of policy interventions in expanding access to these products, although the feasibility of such interventions need strong commitment from decision-makers, as well as implying increased autonomy to the entities involved in reimbursement procedures. Further research is needed to assess the impact of endogenous and exogenous factors in a coherent framework.

Severe exacerbations and mortality in COPD patients: A retrospective analysis of the database of the Hungarian National Health Insurance Fund

IntroductionCOPD is one of the most common pulmonary diseases and one of the leading causes of death worldwide. Exacerbations of COPD include acute worsening that could lead to hospitalization and death. In this study, our objective was to investigate the natural course of moderate and severe exacerbations (SAE) and mortality in the Hungarian population in the past decade. MethodsA retrospective financial database analysis was performed to examine the risk of additional SAEs and death after the first ever SAE in COPD patients, using the financial database of the Hungarian National Health Insurance Fund (NHIF). Patients were enrolled between 2009.01.01. and 2019.12.31. if they had received at least one inhaled drug (LABA, LAMA, ICS or SABA/SAMA) and had been hospitalized for a COPD exacerbation (ICD-10 code J44). ResultsA total of 63,037 patients with COPD were enrolled after their first SAE. Of them, 27,095 patients suffered at least one subsequent SAE, and 32,120 patients died during the 10-year follow-up. The median survival was 4.7 years. The risk of subsequent hospitalizations increased significantly after each SAE, with hazard ratios ranging from 1.65 to 5.01. The risk for mortality was increased after each SAE, but did not increase further with the number of SAEs. Moreover, the risk for subsequent SAE and death increased with moderate exacerbations; however, this risk did not increase further with each event. ConclusionsDespite a relevant improvement in COPD treatment, the natural course of exacerbations remained unchanged. This result highlights the importance of preventing exacerbations and the need for more research to better predict them.

Underlying reasons for post-mortem diagnosed lung cancer cases - A robust retrospective comparative study from Hungary (HULC study).

The Hungarian Undiagnosed Lung Cancer (HULC) study aimed to explore the potential reasons for missed LC (lung cancer) diagnosis by comparing healthcare and socio-economic data among patients with post-mortem diagnosed LC with those who were diagnosed with LC during their lives. This nationwide, retrospective study used the databases of the Hungarian Central Statistical Office (HCSO) and National Health Insurance Fund (NHIF) to identify patients who died between January 1, 2019 and December 31, 2019 and were diagnosed with lung cancer post-mortem (population A) or during their lifetime (population B). Patient characteristics, socio-economic factors, and healthcare resource utilization (HCRU) data were compared between the diagnosed and undiagnosed patient population. During the study period, 8,435 patients were identified from the HCSO database with LC as the cause of death, of whom 1,203 (14.24%) had no LC-related ICD (International Classification of Diseases) code records in the NHIF database during their lives (post-mortem diagnosed LC population). Post-mortem diagnosed LC patients were significantly older than patients diagnosed while still alive (mean age 71.20 vs. 68.69 years, p<0.001), with a more pronounced age difference among female patients (difference: 4.57 years, p<0.001), and had significantly fewer GP (General Practitioner) and specialist visits, X-ray and CT scans within 7 to 24 months and 6 months before death, although the differences in GP and specialist visits within 7-24 months did not seem clinically relevant. Patients diagnosed with LC while still alive were more likely to be married (47.62% vs. 33.49%), had higher educational attainment, and had more children, than patients diagnosed with LC post-mortem. Post-mortem diagnosed lung cancer accounts for 14.24% of total lung cancer mortality in Hungary. This study provides valuable insights into patient characteristics, socio-economic factors, and HCRU data potentially associated with a high risk of lung cancer misdiagnosis.

Antibiotic use in elderly patients in ambulatory care: A comparison between Hungary and Sweden.

Background: The elderly use antibiotics frequently due to their increasing infection susceptibility. Given the high and increasing proportion of elderly in the population, their antibiotic use is substantial. Objective: This study aimed to compare antibiotic use in the elderly in the ambulatory care sector between Hungary and Sweden. Methods: This retrospective, descriptive, cross-national, comparative study included antibacterial use data from the Hungarian National Health Insurance Fund and the Swedish eHealth Agency. Antibiotic use (anatomical therapeutical chemical: J01) was expressed as the number of prescriptions/1000 inhabitants/year or month and was further stratified by age and sex. Results: Antibiotic exposure was higher in the Hungarian elderly population (649.8 prescriptions/1000 inhabitants/year) compared to its Swedish counterparts (545.0 prescriptions/1000 inhabitants/year). Hungary had a similar scale of antibacterial exposure across all elderly age subgroups, with different trends in males and females, while Sweden had a stepwise increase in antibiotic exposure by age in both sexes. The seasonal fluctuation was high in Hungary and reached a peak of 80.7 prescriptions/1000 inhabitants/month in January 2017, while even antibiotic use was detected throughout the year in Sweden. The pattern of antibiotic use in the elderly considerably differed between the two countries. Penicillin and beta-lactamase combinations, such as co-amoxiclav, were more frequently used in Hungary than in Sweden (19.08% vs 1.83% of corresponding total ambulatory antibiotic use). Likewise, quinolones were more commonly used in Hungary than in Sweden (34.53% vs. 9.98). The elderly in Sweden were mostly prescribed narrow spectra penicillins (26.71% vs. 0.29% in Hungary). Conclusion: This cross-national comparison revealed important differences in all aspects of antibiotic use in the elderly between the two countries. The identical scale and pattern of antibiotic use cannot be anticipated due to the poorer health status of the Hungarian elderly population. However, the substantial differences indicate some room for improvement in the antibiotic prescription for the Hungarian elderly.

High risk of depression, anxiety, and an unfavorable complex comorbidity profile is associated with SLE: a nationwide patient-level study

ObjectivesThe aim of this national population-based, retrospective database study is to compare the comorbidity profiles of systemic lupus erythematosus (SLE) patients and general population controls matched for age, gender, and region and assess the risk of depression or anxiety when controlled for age, gender and adjusted for the Charlson Comorbidity Index (CCI).MethodsClaims data of 1051 patients diagnosed with SLE (full population between January 01, 2011, and December 31, 2014) from the Hungarian National Health Insurance Fund have been analyzed against matched controls (1:5 ratio) with a follow-up of 30 months. The first record of SLE diagnosis was considered the diagnosis date. The odds ratio (OR) and 99.9% confidence interval (CI) of having depression or anxiety among patients with SLE vs. controls have been assessed using logistic regression models.ResultsSLE patients report more comorbidities than the matched general population both in pre- and post-index periods (mean CCI 1.79 vs. 1.15 and 2.78 vs. 1.22 [both p<0.001], respectively). Both SLE patients and controls diagnosed with depression or anxiety had significantly higher CCI than those without comorbid depression or anxiety (p<0.001). However, SLE patients had a twofold higher risk of depression or anxiety than matched controls when controlled for age, gender, and adjusted for CCI.ConclusionOur analysis indicates the enormity of comorbidity burden in SLE, especially that of anxiety and depression. The size and complexity of the comorbidity burden emphasizes the importance of early diagnosis and intervention with comprehensive modalities incorporating attention to comorbidities in SLE patients.

POSA188 Epidemiological Disease Burden of Non-Insulin-Dependent Diabetes with Peripheral Circulatory Complications Based on Routinely Collected Health Insurance Claims Data

Circulatory complications of diabetes such as gangrene, ulcer, or angiopathy could be associated with significant decrease in quality of life and can increase individual and health insurance costs. Our aim was to determine the epidemiological disease burden of type 2 diabetes with peripheral circulatory complications in Hungary. Data were derived from the financial database of the Hungarian National Health Insurance Fund Administration, for the year 2018. Data analysed included annual patient numbers, case numbers and prevalence of care utilisation per 100.000 population according to age groups and sex. The following health insurance treatment categories were included into our study: general practice care, home care, in- and outpatient care, medical imaging, laboratory diagnostics, drugs and medical aids. Patients were identified with the following code of the International Classification of Diseases 10th revision: E1150. The highest patient numbers were in outpatient care: 4,874 men, 3,545 women, in total 8,419 patients, followed by general practice care (4,177 men, 3,308 women, in total 7,485 patients), and the use of pharmaceuticals (2,623 men, 2,005 women, in total 4,628 patients). Based on patient numbers in pharmaceuticals, prevalence in 100,000 among men was 56.1 patients, among women 39.3, in total 47.3 patients. Apart from the >70-year-old group, men tend to have higher patient numbers, and they also have higher prevalence in all age groups. Patient numbers increase dramatically above 60 years: they account for 79.56% of the patient population. Regarding sex, in outpatient care 57.9% were men, 42.1% were women, while in the use of pharmaceuticals 56.7% were men and 43.3% were women. Prevalence of these types of complications was 1.43 times higher in men than in women. Prevention and timely treatment of circulatory complications are crucial to reduce the mortality from diabetes and other cardiovascular diseases.

POSB81 Annual Health Insurance Treatment Cost of Heart Failure, Unspecified Based on Routinely Collected Financing Data

Heart failure, unspecified mean a significant economic burden for society. Our aim was to determine the annual health insurance treatment cost of heart failure, unspecified in Hungary. Data were derived from the financial database of the Hungarian National Health Insurance Fund Administration (NHIFA), for the year 2018. Data analysed included annual health insurance costs, patient numbers and cost distribution calculated for age groups and sex. The following cost categories were included into the study: general practice care, home care, in- and outpatient care, medical imaging, laboratory diagnostics, pharmaceuticals and medical aids. Patients with heart failure, unspecified were identified with the following code of the International Classification of Diseases 10th revision: I5090. In 2018, the NHIFA spent 2.45 billion Hungarian Forints (HUF) on the treatment of patients with heart failure, unspecified, 9.08 million American Dollars (USD), or 7.69 million Euros (EUR). 49.6% of costs was spent on the treatment of male, 50.4% on female patients. The highest patient numbers were in general practice care: 35,353 men (40.8%), and 51,302 women (59.2%), in total 86,655 patients. Acute inpatient care (59.0% of total health insurance costs in men, 54.4% in women), pharmaceuticals (12.8% in men, 14% in women) and general practice care (10.6% in men, 14.7% in women) were the main cost drivers, while all other forms of medical care amounted to 17.6% in men and 17% in women. Annual health care treatment cost per patient was 358,540 HUF (1327 USD/1124 EUR) in men and 332,312 HUF (1230 USD/1042 EUR) in women. Acute inpatient care was the major cost driver in the treatment of heart failure, unspecified. Major cost drivers showed no significant difference between men and women. Moderate difference was found in average annual health insurance costs per patient between the sexes.

Comparative Effectiveness of Second Generation Long-acting Injectable Antipsychotics Based on Nationwide Database Research in Hungary: An Update

AbstractGreater 1-year and 2-year treatment continuation rates and longer median time to discontinuation for second-generation antipsychotic (SGA) long-acting injectables (LAIs) vs oral antipsychotics (OAPs) in Hungary were previously reported. This study reports an updated comparison between new LAIs vs OAPs in Hungary. De-identified claims data from Hungarian National Health Insurance Fund database of schizophrenia patients who were newly initiated on SGAs (November 01, 2016 to June 30, 2017) were retrospectively analyzed. Primary outcomes were likelihood of all-cause 1-year and 1.5-year discontinuation of newly initiated SGA and median time till discontinuation. Among 5400 patients, 3977 (73.6%) were OAP users and 1423 (26.4%) were LAI users. The 1-year continuation rate were 12.7% (risperidone)–34.1% (olanzapine) for OAPs and 26.4% (risperidone LAI)–78.6% (paliperidone 3-monthly [PP3M]) for LAIs. The 1.5-year continuation rates were 9.3%–29.5% for OAPs and 24.9%–76.4% for LAIs. Median (95% CI) time to discontinuation was 52 (33–67) days (clozapine)–152 (134–168) days (aripiprazole) for OAPs and 125 (64–196) days (risperidone LAI)–491 (250–not reached) days (aripiprazole LAI) for LAIs. All-cause discontinuation risk was significantly higher in all OAPs vs PP3M and aripiprazole LAI (P &amp;lt; .01) as well as in each LAI vs PP3M (P &amp;lt; .05). Patients switching on new LAIs from another LAI remained longer than those who switched from OAPs/no previous treatment. Results showed the advantage of LAIs over OAPs in terms of time to treatment discontinuation. Moreover, new SGA LAIs (PP3M) seem to be better than previous LAIs in terms of time to treatment discontinuation.

Improvement in age- and sex-dependent mortality in patients with atrial fibrillation between 2011 and 2016 – a nationwide retrospective study from Hungary

IntroductionAtrial fibrillation (AF) is associated with a higher risk of mortality; however, detailed analysis on the excess risk of death of patients diagnosed with AF compared to a non-AF population has not been carried out.Material and methodsIn our nationwide study, all AF patients were included if the I48 ICD-code was recorded twice in the Hungarian National Health Insurance Fund (NHIF) database between 2009 and 2016. The annual mortality rates and rate ratios of AF patients compared with the non-AF population (excess risk) were evaluated as well as the change of these parameters between 2011 and 2016.ResultsWe identified 88,848 to 123,255 females and 80,525 to 116,448 males between 2011 and 2016 in the database. The excess risk of AF compared to the non-AF population was higher in females: the rate ratio (RR) was 4.47 (95% CI: 4.35–4.58; p &lt; 0.001) versus 3.34 (95% CI: 3.27–3.40; p &lt; 0.001) in 2011. We found significant reductions in the mortality rates of the AF population between 2011 and 2016 (18.0% p = 0.037 in females and 17.7% p &lt; 0.001 in males) while reductions in excess mortality were significant in the older age groups (age 60 years and above). Though the age-specific mortality rates were higher among the older population and in males, mortality RR was higher in the lower age groups and in females.ConclusionsBy implementing a novel methodology, we were able to express the mortality risk of the total AF population. We found relevant reduction in the age-standardised mortality rates in both sexes during this 6-year period, which exceeded the reduction of mortality rates in the non-AF population.

PIH7 ANNUAL HEALTH INSURANCE TREATMENT COST OF CERVICAL CANCER BASED ON ROUTINELY COLLECTED NATIONWIDE REAL-WORLD FINANCING DATA IN HUNGARY

Cervical cancer represents a significant burden for the individual and the society. The aim of our study was to determine the annual health insurance treatment cost of cervical cancer in Hungary. Data were derived from the financial database of the Hungarian National Health Insurance Fund Administration (NHIFA), for the year 2018. Data analysed included annual health insurance costs, patient numbers and cost distribution calculated for age groups and sex. The following cost categories were included into the study: general practice care, home care, in- and outpatient care, medical imaging, laboratory diagnostics, pharmaceuticals and medical aids. Patients with cervical cancer were identified with the following code of the International Classification of Diseases 10th revision: C53. In 2018, the Hungarian National Health Insurance Fund Administration spent 1.238 billion Hungarian Forints (HUF) on the treatment of patients with endometriosis, which equals to 4.58 million American Dollars (USD), or 3.88 million Euros (EUR). We found he highest patient numbers in outpatient care: 5,208 patients, resulting in a prevalence of 53.3 patients/100,000 female population. Acute inpatient care (60.0% of total health insurance costs), CT imaging examinations (18.2%) and reimbursement of pharmaceuticals (6.9%) were the main cost drivers, while all other forms of medical care amounted to 14.9%. Annual health care treatment cost per patient was 237,675 HUF (879 USD/745 EUR)for women. Acute inpatient care was the major cost driver in the treatment of cervical cancer primarily, due to the surgical interventions often required for its treatment. CT imaging examinations play important role in the diagnosis of disease and in the monitoring of treatment. The treatment of patients aged 45-74 accounted for 70.0% of costs.

PIH44 EPIDEMIOLOGICAL DISEASE BURDEN OF FEMALE INFERTILITY BASED ON ROUTINELY COLLECTED HEALTH INSURANCE CLAIMS DATA

Assisted reproductive technologies for the treatment of infertility have shown a continuous increase. Several diseases may lead to infertility; endometriosis may be in the background. The aim of our study was to determine the epidemiological disease burden of female infertility. Data were derived from the financial database of the Hungarian National Health Insurance Fund Administration (NHIFA), for the year 2018. Data analysed included annual patient numbers, case numbers and prevalence of care utilisation per 100.000 population, according to age groups and sex. The following health insurance treatment categories were included into our study: general practice care, home care, in- and outpatient care, medical imaging, laboratory diagnostics, drugs and medical aids. Patients with female infertility were identified with the following code of the International Classification of Diseases 10th revision: N97. The highest national patient numbers were found in outpatient care: in total 30,112 patients, followed by the use of pharmaceuticals: in total 18,522 patients and laboratory diagnostics with 14,765 patients. Based on patient numbers in outpatient care, prevalence in 100,000 among women was 589.6 patients, while prevalence calculations based on the use of pharmaceuticals resulted in 362.7 patients. Prevalence calculations based on acute inpatient care including hospitalisation resulted in a prevalence of 178.6 patients per 100,000 population. Regarding prevalence, a 3.3-fold difference was found between outpatient care, mainly including diagnostic interventions, and acute inpatient care including hospitalisation. Diseases associated with female infertility may significantly affect the health of the patient the treatment of which is necessary to help fulfil the reproductive wishes of patients.

PND63 EPIDEMIOLOGICAL DISEASE BURDEN OF SLEEP APNOEA BASED ON ROUTINELY COLLECTED HEALTH INSURANCE CLAIMS DATA

Inadequate sleep quality has a considerable impact on quality of life resulting in problems at work and private life as well. Traffic accidents associated with sleep apnoea have become an area of utmost concern. The aim of our study was to determine the epidemiological disease burden of sleep apnoea. Data were derived from the financial database of the Hungarian National Health Insurance Fund Administration (NHIFA), for the year 2018. Data analysed included annual patient numbers, case numbers and prevalence of care utilisation per 100.000 population according to age groups and sex. The following health insurance treatment categories were included into our study: general practice care, home care, in- and outpatient care, medical imaging, laboratory diagnostics, drugs and medical aids. Patients with sleep apnoea were identified with the following code of the International Classification of Diseases 10th revision: G4730. The highest national patient numbers were in outpatient care: 13,752 men and 5,204 women in total 18,956 patients, followed by general practice care (6,321 men and 2,496 women, in total 8,817), and case numbers associated with the utilisation of medical aids (5,964 men, 1,535 women, in total 7,499). Based on patient numbers in outpatient care, prevalence in 100,000 among men was 294.4 patients, among women 101.9 patients, in total 193.9 patients. As regards sex distribution in outpatient care 72.5% of patients were men and 27.5% were women, while in the case of medical aids utilisation 79.5% were men and 20.5% were women. Prevalence of sleep apnoea was found to be 2.9 times higher among men than among women. Special attention should be paid to male drivers.

PSY10 ANNUAL HEALTH INSURANCE TREATMENT COST OF RHEUMATOID ARTHRITIS BASED ON ROUTINELY COLLECTED FINANCING DATA

Increased utilisation of services related to the treatment of rheumatoid arthritis pose an increased burden for healthcare systems as well. Our aim was to determine the annual health insurance treatment cost of rheumatoid arthritis in Hungary. Data were derived from the financial database of the NHIFA, for the year 2018. Data analysed included annual health insurance costs, patient numbers and cost distribution calculated for age groups and sex. The following cost categories were included into the study: general practice care, home care, in- and outpatient care, medical imaging, laboratory diagnostics, pharmaceuticals and medical aids. Patients with rheumatoid arthritis were identified with the following code of the International Classification of Diseases 10th revision: M0690. In 2018, the Hungarian National Health Insurance Fund Administration spent 1.64 billion Hungarian Forints (HUF) on the treatment of patients with rheumatoid arthritis [6.07 million American Dollars (USD), or 5.14 million Euros (EUR)]. 19.3% of costs was spent on the treatment of male, 80.7% on female patients. The highest patient numbers were in general practice care: 8,075 men (22.8%), 27,282 women (77.2%) in total 35,357 patients. Pharmaceuticals (50.5% of total health insurance costs in men, 40.9% in women), outpatient care (19.0% in men, 22.6% in women) and acute inpatient care (10.7% in men, 12.9% in women) were the main cost drivers, all other forms of medical care amounted to 19.8% in men and 23.6% in women. Annual health care treatment cost per patient was 39,223 HUF (145 USD/123 EUR)in men and 48,475 Ft (179 USD/152 EUR) in women. Use of pharmaceuticals was the major cost driver in the treatment of rheumatoid arthritis. Distribution of major cost drivers showed a difference between the sexes. The average annual health insurance costs per patient was 24% higher in women.

PND65 EPIDEMIOLOGICAL DISEASE BURDEN OF INTRACRANIAL INJURY BASED ON ROUTINELY COLLECTED HEALTH INSURANCE CLAIMS DATA

The clinical significance of intracranial injuries is due to their high prevalence and high mortality. The aim of our study was to determine the epidemiological disease burden of intracranial injury. Data were derived from the financial database of the Hungarian National Health Insurance Fund Administration (NHIFA), for the year 2018. Data analysed included annual patient numbers, case numbers and prevalence of care utilisation per 100,000 population according to age groups and sex. The following health insurance treatment categories were included into our study: general practice care, home care, in- and outpatient care, medical imaging, laboratory diagnostics, drugs and medical aids. Patients with intracranial injury were identified with the following code of the International Classification of Diseases 10th revision: S06. The highest national patient numbers were in CT diagnostics: 10,019 men and 8,950 women, in total 18,969 patients, followed by outpatient care (7,748 men and 6,461 women, in total 14,209 patients), and general practice care (6,529 men and 5,800 women, in total 12,329). Based on patient numbers requiring hospital care in the acute inpatient care, prevalence in 100,000 among men was 91.9 patients, among women 56.2 patients, in total 73.2. Average age of patients of inpatient care was 51.9 years, there was significant difference (5.0 years) between men (49.9 years) and women (54.9 years). As regards sex distribution in the use of CT diagnostics: 52.8% of patients were men, 47.2% were women, in outpatient care men accounted for 54.5%, women for 45.5% of patients. Prevalence of intracranial injury was 1.63-times higher among men than among women. Average age of women was 5.0 years higher than that of men. High patient numbers are attributable to the fact that in the case of patients with intracranial injury CT is the primary diagnostic method.