Hungarian National Health Insurance Fund Research Articles

Different Changes of Risks for Stroke and Myocardial Infarction in Patients With Type 2 Diabetes in Hungary Between the Two Periods of 2001-2004 and 2010-2013.

Objective: In recent decades several studies reported significant changes in the mortality and morbidity of patients with type 2 diabetes. In this Hungarian nationwide study, we assessed the changes of mortality and cardiovascular risks comparing a group of patient diagnosed during the two periods of 2001–2004 and 2010–2013.Research Design and Methods: We identified patients with type 2 diabetes recorded in the database of the Hungarian National Health Insurance Fund aiming to assess changes of risks for all-cause mortality, myocardial infarction, and stroke during the follow-up periods of 48 months.Results: We included 274,109 patients with newly diagnosed type 2 diabetes between 2001 and 2004, while only 152,678 in the 2010–2013 period. The risk of all-cause mortality at the beginning of the follow-up was not different comparing 2010–2013 to 2001–2004 (HR 1.03), and a mild but significant decrease could be detected (HR 0.87) after 48 months. A lower risk for myocardial infarction was documented in the second month after the diagnosis of diabetes (HR 0.67), which remained constant during the study period and almost the same after 48 months (HR 0.73). On the contrary, our study verified a slightly increased risk for stroke close to the diagnosis [HR 1.06 (1.00–1.13)] and a decreased one [HR 0.72 (0.69–0.79)] at the end of the study.Conclusions: An increased risk for stroke followed by a sharp decrease, and an unchanged risk for myocardial infarction in the Hungarian population with type 2 diabetes possibly resulted in a mild decrease of all-cause mortality between 2001 and 2013.

Price competition and reimbursement of biosimilar granulocyte-colony stimulating factor in Hungary

ABSTRACTObjectives: We analyzed the bid approach of the Hungarian National Health Insurance Fund Administration (NHIFA) based on the results of two consecutive bids on colony stimulating factor (CSF).Methods: The Hungarian NHIFA database was used to analyze the changes in the number of patients treated with CSF and reimbursement paid by NHIFA, 12 months preceding and following the bids.Results: 13,974 patients received granulocyte-CSF treatment during 12 months prior to bidding. A 4.5% decrease (13,352) and further 1.3% decrease (13,185) in the total number of patients were observed during the first and second years, respectively. The annual health insurance subsidy paid during 12 months prior to the bids was. 7.49 billion Hungarian Forint (HUF) or 26.8 million Euro (EUR). In the first year following the bid, we found a 3.3 billion HUF (12.4 million EUR) decrease in health insurance subsidy (44% reduction). A further 7.9% reduction was observed during the second year, resulting in an annual health insurance subsidy of 3.59 billion HUF (12.1 million EUR).Conclusion: During the 2 years bid (public procurement procedure), the National Health Insurance Fund Administration managed to reduce the health insurance subsidy paid for the reimbursement of both original and biosimilar G-CSF products.

PCV57 - HEALTH INSURANCE COST OF HYPERTENSIVE HEART DISEASE IN HUNGARY: A NATIONWIDE COST OF ILLNESS STUDY

Hypertensive heart disease is a common disease resulting in significant health insurance cost and societal burden in many developed countries.The aim of our study was to calculate the annual health insurance treatment cost of hypertensive heart disease in Hungary. The data derive from the financial database of the Hungarian National Health Insurance Fund Administration (NHIFA), the only health care financing agency in Hungary. We analyzed the health insurance treatment cost and the number of patients for the year 2017. The following cost categories were included into the study: out-patient care, laboratory diagnostics, medical imaging, acute in-patient care, chronic in-patient care and drugs. Hypertensive heart disease was identified with the following codes of the International Classification of Diseases 10threvision: I11. The number of patient underwent outpatient care was 43,194 (54.4 % women and 45.6 % men) with a mean age of 67.79 years (women: 69.44 years; men: 65.83 years). Number of patients admitted to in-patient hospital care was 29,598 (55.3 % women and 44.7 % men) with a higher mean age of 71.24 years (women: 73.39 years; men:68.57 years). For the treatment of patients with hypertensive heart disease in 2017 the Hungarian National Health Insurance Fund Administration spent 8.097 billion Hungarian Forint (HUF) which equals 26.189 million Euros (EUR). Major cost drivers were acute inpatient care (86.7 %), chronic inpatient care (5.8 %) and out-patient care (3.7 %). Hypertensive heart disease represents a significant burden for the health insurance system. Proportion of women is higher both in outpatient and inpatient care. There is a significant difference (outpatient: 3.6 years; inpatient: 4.8 years) in the onset of the disease between women and men. Reimbursement of acute inpatient care is the major cost driver for hypertensive heart disease in Hungary.

PMU49 - HEALTH INSURANCE COST OF PSORIASIS IN HUNGARY: COST OF ILLNESS STUDY BASED ON REAL WORLD DATA

Psoriasis is an increasing cause of morbidity in developing and in industrialized regions. The aim of our study was to calculate the annual health insurance treatment cost of psoriasisin Hungary. The data were derived from the financial database of the Hungarian National Health Insurance Fund Administration (NHIFA), the only health care financing agency in Hungary. We analyzed the number of patients and the health insurance treatment cost for the year 2017. The following cost categories were included into the study: out-patient care, laboratory diagnostics, medical imaging, acute in-patient care, chronic in-patient care and drugs. Patients with psoriasis were identified with the following codes of the International Classification of Diseases 10threvision: L40. Number of patients admitted to in-patient hospital care was 5,333 (50.6 % women and 49.4 % men) with a mean age of 59.78 years (women: 59.93 years; men: 59.62 years). The number of patient underwent outpatient care was 41,614 (50.8 % women and 49.2 % men) with a mean age of 53.40 years (women: 53.86 years; men: 52.93 years). For the treatment of patients with psoriasis in 2017 the Hungarian National Health Insurance Fund Administration spent 2.569 billion Hungarian Forint (HUF) which equals 8.309 million Euro (EUR). Major cost drivers were pharmaceuticals (38.7 % of total health insurance costs), acute inpatient care (37.0 %) and outpatient care (14.4 %). Psoriasisrepresent a significant burden for the Hungarian health insurance system. This disease proved to be equally common among Hungarian women and men. There was no significant difference in the onset of the disease between women and men.

PCV58 - HEALTH INSURANCE TREATMENT COST OF SECONDARY HYPERTENSION IN HUNGARY: A NATIONWIDE COST OF ILLNESS STUDY

Secondary hypertension is a common disease resulting in significant health insurance cost and societal burden in many developed countries.The aim of our study was to calculate the annual health insurance treatment cost of secondary hypertension in Hungary. The data derive from the financial database of the Hungarian National Health Insurance Fund Administration (NHIFA), the only health care financing agency in Hungary. We analyzed the health insurance treatment cost and the number of patients for the year 2017. The following cost categories were included into the study: out-patient care, laboratory diagnostics, medical imaging, acute in-patient care, chronic in-patient care and drugs. Secondary hypertension was identified with the following codes of the International Classification of Diseases 10threvision: I15. The number of patient underwent outpatient care was 5,740 (55.1 % women and 44.9 % men) with a mean age of 57.94 years (women: 60.48 years; men: 54.83 years). Number of patients admitted to in-patient hospital care was 2.929 (59.2 % women and 40.8 % men) with a higher mean age of 61.98 years (women: 64.55 years; men:58.11 years). For the treatment of patients with secondary hypertension in 2017 the Hungarian National Health Insurance Fund Administration spent 780.266 million Hungarian Forint (HUF) which equals 2.523 million Euros (EUR). Major cost drivers were acute inpatient care (72.8 % of total health insurance costs), pharmaceuticals (17.7 %) and chronic inpatient care (5.5 %). Secondary hypertension represents a significant burden for the health insurance system. The occurrence of the disease is more common in women both in outpatient and inpatient care. There is a significant difference (outpatient: 5.64 years; inpatient: 6.54 years) in the onset of the disease between women and men. Reimbursement of inpatient care is the major cost driver for secondary hypertension in Hungary.

PMS7 - Health Insurance Burden of Sport Related Medical Conditions: Treatment Cost of The Injuries of Lower Leg

Sport related injuries are of public health importance and generates a considerable health insurance burden. The aim of our study was to calculate the annual health insurance treatment cost of injuries of muscle, fascia and tendon at lower leg level in Hungary. The data were derived from the financial database of the Hungarian National Health Insurance Fund Administration (NHIFA), the only health care financing agency in Hungary. We analyzed the number of patients and the health insurance treatment cost for the year 2016. The following cost categories were included into the study: out-patient care, laboratory diagnostics, medical imaging, acute in-patient care, chronic in-patient care and drugs. Patients with injury of muscle, fascia and tendon at lower leg level were identified with the following codes of the International Classification of Diseases 10th revision: S86. The number of patient underwent outpatient care was 12,218 (27.4% women and 72.6% men) with a mean age of 45.81 years (women: 47.33 years; men: 45.23 years). Number of patients admitted to in-patient hospital care was 1,139 (15.9% women and 84.1% men) with a mean age of 44.69 years (women: 48.28 years; men: 44.01 years). For the treatment of patients with injuries of muscle, fascia and tendon at lower leg level in 2016 the Hungarian National Health Insurance Fund Administration spent 213.8 million Hungarian Forint (HUF) which equals 0.759 million American Dollars (USD) or 0.823 million Japanese Yen (JPY). Major cost drivers were acute inpatient care (69.2% of total health insurance costs) and out-patient care (26.3%). Injury of muscle, fascia and tendon at lower leg level represents a significant burden for the Hungarian health insurance system. The disease is more common in men (72-84%) than women. There is a significant difference (2-4 years) in the onset of the disease between women and men.

PCN29 - Health Insurance Cost of Malignant Neoplasm of Bronchus and Lung in Hungary: Cost of Illness Study Based on Real World Data

Malignant neoplasm of bronchus and lung represents a leading cause of death in developed countries. The aim of our study was to calculate the annual health insurance treatment cost of malignant neoplasm of bronchus and lung in Hungary. The data were derived from the financial database of the Hungarian National Health Insurance Fund Administration (NHIFA), the only health care financing agency in Hungary. We analyzed the number of patients and the health insurance treatment cost for the year 2016. The following cost categories were included into the study: out-patient care, laboratory diagnostics, medical imaging, acute in-patient care, chronic in-patient care and drugs. Patients with malignant neoplasm of bronchus and lung were identified with the following codes of the International Classification of Diseases 10th revision: C34. Number of patients admitted to in-patient hospital care was 22,896 (40.7 % women and 59.3 % men) with a mean age of 64.64 years (women: 64.41 years; men: 64.79 years). The number of patient underwent outpatient care was 209,640 (44.3 % women and 55.7 % men) with a mean age of 64.64 years (women: 64.16 years; men: 65.02 years). For the treatment of patients with malignant neoplasm of bronchus and lung in 2016 the Hungarian National Health Insurance Fund Administration spent 12.02 billion Hungarian Forint (HUF) which equals 42.707 million American Dollars (USD) or 46.3 million Japanese Yen (JPY). Major cost drivers were acute inpatient care (65.2 % of total health insurance costs), pharmaceuticals (22.2 %) and outpatient care (9.1 %). Malignant neoplasm of bronchus and lung represent a significant burden for the Hungarian health insurance system. The disease is more common in men (55-59 %) than women. The average age of the onset of the disease was almost the same (64 years) in both women and men.

PMS14 - Health Insurance Burden of Sport Related Medical Problems: Treatment Cost of Dislocation and Sprain of Joints and Ligaments At Ankle

Sport related injuries are of public health importance and generates a considerable economic burden. The aim of our study was to calculate the annual health insurance treatment cost of dislocation and sprain of joints and ligaments at ankle, foot and toe level in Hungary. The data were derived from the financial database of the Hungarian National Health Insurance Fund Administration (NHIFA), the only health care financing agency in Hungary. We analyzed the number of patients and the health insurance treatment cost for the year 2016. The following cost categories were included into the study: out-patient care, laboratory diagnostics, medical imaging, acute in-patient care, chronic in-patient care and drugs. Patients with dislocation and sprain of joints and ligaments at ankle, foot and toe level were identified with the following codes of the International Classification of Diseases 10th revision: S93. The number of patient underwent outpatient care was 144,809 (51.7% women and 48.3% men) with a mean age of 33.26 years (women: 36.29 years; men: 30.02 years). Number of patients admitted to in-patient hospital care was 467 (46.9% women and 53.1% men) with a mean age of 33.84 years (women: 35.20 years; men: 32.65 years). For the treatment of patients with this condition in 2016 the Hungarian National Health Insurance Fund Administration spent 425.6 million Hungarian Forint (HUF) which equals 1.51 million American Dollars (USD) or 1.64 million Japanese Yen (JPY). Major cost drivers were out-patient care (59.1% of total health insurance costs), medical imaging (24.6%) and acute inpatient care (11.9%). Dislocation and sprain of ankle represents a significant burden for the Hungarian health insurance system. The disease is equally common in men and women. There is a significant difference (2-6 years) in the onset of the disease between women and men.

PCV23 - Health Insurance Cost Of Atherosclerosis In Hungary: Cost Of Illness Study Based On Real World Data

Atherosclerosis is of public health importance and generates a considerable economic burden. The aim of our study was to calculate the annual health insurance treatment cost of atherosclerosis of native arteries of the extremities in Hungary. The data were derived from the financial database of the Hungarian National Health Insurance Fund Administration (NHIFA), the only health care financing agency in Hungary. We analyzed the number of patients and the health insurance treatment cost for the year 2016. The following cost categories were included into the study: out-patient care, laboratory diagnostics, medical imaging, acute in-patient care, chronic in-patient care and drugs. Patients with atherosclerosis of native arteries of the extremities were identified with the following codes of the International Classification of Diseases 10th revision: I70.2. The number of patient underwent outpatient care was 80,011 (36.3 % women and 63.7 % men) with a mean age of 67.49 years (women: 69.37 years; men: 66.42 years). Number of patients admitted to in-patient hospital care was 14,998 (35.7 % women and 64.3 % men) with a mean age of 67.61 years (women: 70.10 years; men: 66.23 years). For the treatment of patients with atherosclerosis of native arteries of the extremities in 2016 the Hungarian National Health Insurance Fund Administration spent 5.8 billion Hungarian Forint (HUF) which equals 20.67 million American Dollars (USD) or 22.4 million Japanese Yen (JPY). Major cost drivers were acute inpatient care (58.4 % of total health insurance costs), medical imaging (13.9 %) and out-patient care (9.4 %). Atherosclerosis of native arteries of the extremities represents a significant burden for the Hungarian health insurance system. The disease is more common in men (63-64 %) than women. There is a significant difference (3-4 years) in the onset of the disease between women and men.

PMS4 - 180-Day Mortality and Its Predictors In Men With Contralateral Hip Fracture After Femoral Neck Fracture

There is a high mortality with not well understood risk factors after the contralateral hip fracture. The aim of the study was to analyse the 180-day mortality and its risk factors in men with contralateral hip fracture. Men aged 60 years and over treated with primary femoral neck fractures in the year 2000 and suffered from contralateral hip fractures between 01 January 2000 and 31 December 2008 were selected from the database of the Hungarian National Health Insurance Fund. Risk factors as age, comorbidities, type of fracture and surgery, surgical complications, day of hospital admission were analyzed by multinominal logistic and Cox regression analysis (p<0.05). Statistical tests were performed using the SPSS version 19.0. 49 men met the criteria with 38.80% mortality rate at 180 day respectively. Logistic regression analysis showed significantly higher risk for mortality in men with higher age (OR: 1.169) at 180 day. Cox regression identified higher age (HR: 1.087) and location of contralateral hip fracture (other fracture vs. femoral neck fracture HR: 9.214) as risk factor for 180-day mortality in men. Older age and location of fracture proved to be risk factors for 180-day mortality after contralateral hip fracture in men over 60 years. There is a need to develop an efficacious prevention strategy for the reduction of the mortality after the contralateral hip fractures.

Expenditures Of Metabolic Diseases - An Estimation on National Health Care Expenditures of Diabetes and Obesity, Hungary 2013.

Obesity could be considered as the main consequence of unhealthy nutrition, responsible for many pathological alterations in human. Obese patients usually need more health care services. The aim of the study was to estimate the financial expenditures of health care provisions in Hungary, related to obesity and diabetes, as its main pathological consequence. Data of the Hungarian National Health Insurance Fund (NHIF) were collected for 2013, regarding finances of secondary care, hospital services, reimbursement for medications and healing aids of diabetic patients together with selected morbidities linked to obesity, based on the codes of the International Classification of Diseases (ICD) and calculated their population prevalence on the population-attributable fraction (PAF). Financial data regarding diabetes care resulted in a 40,311 Million HUF (129 Million EUR) national fund expenses, beside a 7,173 Million HUF (23 Million EUR) contribution from patients. Estimated total health care expenditures related to obesity were 58,986 Million HUF (188 Million EUR) and the financial contribution of patients was calculated as 25,316 Million HUF (81 Million EUR). These data represent a 5.2% and 9.3% of the whole national health services, 16% and 30% of the whole drug-reimbursement budgets, respectively. Although expenditures for some obesity related pathologies analyzed in this paper represent 0.28% of the national GDP, considering other morbidities and other patient's expenses, the real ratio could be between 0.5-1%. The increasing number of overweight and obese persons requires more focus in public health, higher awareness in the society and more governmental support.

Persistence to Treatment with DPP-4 Inhibitors, SGLT2 Inhibitors, and GLP-1-RAs Compared with Insulin after Failure with First Antidiabetic Drug in T2DM Patients

Adequate persistence to antidiabetic treatment is highly important to achieve proper glycemic control. Data on persistence with new antidiabetic drugs are limited. The aim of the study was to evaluate the persistence to treatment with DPP-4-inhibitors, SGLT2-inhibitors and GLP-1-RAs in comparison to insulin (INS) in a nationwide cohort of T2DM patients. Using the database of the Hungarian National Health Insurance Fund, the persistence to the treatment with DPP-4-inhibitors (n=59,900), SGLT2-inhibitors (n=26,052), GLP-1-RAs (n=17,332) and INS (n=51,781) was analyzed between 2014 and 2016. We captured the antihyperglycemic agents either in monotherapy or in add-on combinations after failure with first antidiabetic drug. Persistence was defined as the duration of time from initiation to discontinuation of the particular therapy. A permissible gap of 180 days (grace period) was allowed. The results are reported as the rate of persistent patients at year 1 and year 2. The persistence of DPP-4-inhibitors and SGLT2-inhibitors was similar at year 1 (68%, 67%), both of which decreased by year 2 (55% and 56%, respectively). The persistence of GLP-1-RAs was 66% at year 1, which decreased remarkably to year 2 (51%). DPP-4-inhibitors + metformin in fix combination had higher persistence (64% and 50%) than that of free add-on combinations (43% and 29%, at year 1 and year 2, respectively). Similar trend was observed regarding SGLT2-inhibitors + metformin fix vs. free add-on combinations at year 1 (75% vs. 55%). Treatment with INS had a relatively high persistence (71% and 61% at year 1 and year 2, respectively). Persistence to treatment with innovative drugs was the highest in patients with age of 40-60 years. Persistence data of different antihyperglycemic agents provide useful information and should be considered as one of components that help to guide the proper decision at initiation of antidiabetic treatment. Disclosure G. Jermendy: None. G. Rokszin: None. Z. Abonyi-Tóth: None. I. Wittmann: None. P. Kempler: None.

PHP107 - Deficit of the Hungarian Health Insurance Fund Between 1994-2014

The Hungarian health insurance budget showed a huge deficit between 2003-2005. The aim of the study to analyse the deficit of the Hungarian National Health Insurance Fund Administration (OEP), the one and only health insurance fund in Hungary. Data derive from the financial database of the Hungarian National Health Insurance Fund Administration, covering the period 1994-2014. We calculated the deficit of the Fund as difference between revenues and expenditures both in nominal and real values and as a percent of expenditures. In each year between 1994-2014 we found a deficit at the Fund. Between 1994-2002 the deficit was moderate and varied between 3-11 % of expenditures. Between 2003-2005 the deficit increased up to 22-23 % of expenditures. In 2005, there was 6.03 billion USD (1204 billion Hungarian Forint, HUF) revenue, 7.91 billion USD (1579 billion HUF) expenditure, thus the deficit reached 1.9 billion USD (375 billion HUF) which is 23,8 % of expenditures. Between 2006-2008 the deficit decreased to 1.6 % of revenues. Following the outbreak of word economic crisis in 2008, the deficit of the fund increased again to 5-10 % of revenues for the years 2009-2011. For 2013 and 2014 the deficit declined again significantly to less than 0.05 % of revenues. Although between 2003-2005, there was a huge deficit in the Hungarian health insurance budget, in 2006 and 2007 one managed to close the widening gap between revenues and expenditures, which increased again following the outbreak of word economic crises in 2008. For 2013-2014 the fund operated without deficit.

The patients' cost of the montelukast therapy due to the generic substitution

The aim of our study was to analyse the public price of the montelukast sodium therapy in Hungary. Data derived from the nationwide pharmaceutical database of the Hungarian National Health Insurance Fund Administration. We observed the turnover and price of the medicaments containing the active substance montelukast sodium from 2007 to 2015. Accordingly, our indicators were: consumer price, DCT (daily cost of therapy), co-payment, quasi co-payment, DOT (days of treatment). Due to the increasing DOT, the total amount of the public price paid by the patients increased until 2011, reaching the amount of 1 million USD; then, due to the generic competition and the blind bid methods, it decreased to 490 000 USD. The total amount of the public price of the brand-name Singulair moved to the generics during 3 years (2011-2014). The DCT of the originator Singulair 10 mg tablets decreased from 1.1 USD to 0.34 USD; the DCT of the generic product Montelukast TEVA decreased from 0.67 USD to 0.16 USD in the period under review. Due to the generic competition, the patients' access to drugs containing montelukast sodium increased significantly: the DOT increased, the co-payment decreased. Orv Hetil. 2018; 159(17): 682-687.

Experiences With Price Competition Of Biosimilar Drugs In Hungary

The aim of our study is to analyse the biosimilar bids of the Hungarian National Health Insurance Fund Administration in case of colony-stimulating factor and erythropoietin products.Data derived from the nationwide pharmaceutical database of Hungarian National Health Insurance Fund Administration. We analysed how the number of patients treated by colony-stimulating factor and erythropoietin products changed before (01.07.2011.-30.06.2012.) and after (01.07.2012.-30.06.2013.) the first biosimilar bid performed in March 2012 in Hungary.In the 12 months before biosimilar bid 4167 patients received erythropoietin treatment, while in the first 12 months after the bid 3647 patients, resulting in a 12.5 % decline. In the 12 months before biosimilar bid 13974 patients received colony-stimulating factor treatment, while in the first 12 months after the bid 13352 patients, resulting in a 4.5% decline.The analyses of the Hungarian price competition bid of biosimilar products showed a minimal decline in the number of patients under treatment by both colony-stimulating factor and erythropoietin products while the health insurance reimbursement of these drugs significantly decreased.

Penetration of Peripheral Vascular Interventions in Hungary

Our investigation aimed to analyse the penetration of peripheral vascular interventions among Hungarian hospitals, with special respect to the Clinical Center of the University of Pécs, a tertiary level university teaching hospital. Data analysed were taken from the database of the Hungarian National Health Insurance Fund Administration, covering the year 2015. We identified the patients with the Hungarian Diagnosis Related Groups (DRG) categories. We investigated the following DRG groups: 190 C, 190 D, 190 E, 190 F, 190 G, 190 H. Hospitals that had reported patients with these DRG codes were involved into the study. Our investigation focused on case numbers and percentage ratio. The general market share of the Clinical Center of the University of Pécs (CC-UP) was 5.0 % from all the active inpatient care services in 2015. Institutions performing 190C Percutaneous and other vascular surgeries (with the implantation of one or more stents or homograft) reported a total 1111 cases, out of which 135 (12%, which is the second largest market share: 2nd place) was reported by the CC-UP. Institutions performing 190D Percutaneous and other vascular surgeries without stent implantation reported a total 592 cases, according to reported performance, the CC-UP had 229 cases (38.7%, 1st place). Regarding 190E Percutaneous vascular surgeries with further treatment (with one or more stents) the reported number was a total of 1288 cases, out of which the CC-UP carried out 7 (0.5%, 28th place). The total number of 190F Percutaneous vascular surgeries without further treatment including stent implantation amounted to 822, and the CC-UP had 29 cases (3.5 %, 9th place). The case numbers and percentage ratio of peripheral vascular interventions performed at hospitals showed considerable differences, even in a tertiary level teaching hospital. Penetration rate of peripheral vascular interventions should be increased in Hungary.

PCV71 - Health Insurance Cost of Stroke in Hungary: A Cost of Illness Study

The aim of our study is to calculate the annual health insurance treatment cost of stroke in Hungary. The data derive from the financial database of the Hungarian National Health Insurance Fund Administration (NHIFA), the only health care financing agency in Hungary. We analyzed the health insurance treatment cost and the number of patients for the year 2010. The following cost categories were included into the study: out-patient care, in-patient care, CT-MRI, PET, home care, transportation, general practitioner, drugs and medical devices. Stroke was identified with G45-46 and I60-69 codes of the International Classification of Diseases 10threvision. The Hungarian National Health Insurance Fund Administration spent 30.667 billion Hungarian Forint (HUF) (111.35 million EUR) for the treatment of stroke patients. The annual average expenditure per patient was 34869 HUF (126.6 EUR) while the average expenditure per one inhabitant was 3062 HUF (11.1 EUR). Major cost drivers were acute inpatient care (50.2 % of total health insurance costs), chronic inpatient care (9.2 %) and outpatient care (4.3%). The number of patients with stroke was 878.3 per 10000 populations. We found the highest patient number in general practitioners (879509 patients), pharmaceuticals (733965 patients) and outpatient care budget (392305 patients). Stroke represents a significant burden for the health insurance system. Reimbursement of acute and chronic inpatient care are the major cost drivers for stroke in Hungary.

Economic and public health benefits: The result of increased regular physical activity

IntroductionThis study aimed to evaluate mathematical algorithms that could quantify the burden of disease in Hungary and to determine the extent of savings in sick-allowance which could be achieved if inactive lifestyles could be reduced. MethodsData was collected from the Hungarian National Health Insurance Fund Administration, the Central Administration for the National Pension Insurance, the Hungarian Central Statistical Office, and a national large-sample survey (n=1158). Direct costs and indirect burden of various diseases were analysed using economic and labour-related assumptions. The distribution of medical cost coverage between the state, households and employees is described, taking Hungarian commodity- and labour market specifics into consideration. We used the method of population Attributable Risk to quantify the possible savings in sick-allowance due to a reduction in inactivity. ResultsComparison of economic burdens of illnesses between 2005 and 2009 decreased in inflation-corrected real terms. Expanding physical activity was a trigger factor, as logistic regression showed significant correlation between regular sporting activity and sick days of the previous year (p=0.03; Exp(β)=0.760). In 2009, 2.3%–23.6% of all workers applying for sick-allowance lived inactively, and 16 billion HUF in sick-allowances could have been saved had the population inactivity rate not been 77%. Calculation of illness-related burden relating to obesity, hyperlipidaemia, high blood pressure, stroke and type-II diabetes related to metabolic syndrome highlights specific areas where increased physical activity could have a positive effect. ConclusionOnly a 10% increase in physical activity would result in more than 28 billion HUF (ca. 73.7 million GBP) savings for the Hungarian economy.

A Retrospective Longitudinal Database Study of Persistence and Compliance with Treatment of Osteoporosis in Hungary.

This study assessed persistence and compliance with anti-osteoporosis therapies, and associations between compliance and clinical outcomes (fracture, fracture-related hospitalization and death), in Hungarian women with postmenopausal osteoporosis. The study used the Hungarian National Health Insurance Fund Administration database and included women with PMO aged at least50years, for whom a prescription for anti-osteoporosis medication had been filled between 1 January 2004 and 31 December 2013 (index event). Persistence (prescription refilled within 8weeks of the end of the previous supply) was evaluated over 2years; good compliance (medication possession ratio≥80%) was evaluated at 1year. Associations between compliance and clinical outcomes (data collected for up to 6years) were assessed with adjustment for baseline covariates. A total of 296,300 women met the inclusion criteria (524,798 index events). Persistence and compliance were higher for less frequent and parenteral therapies (1- and 2-year persistence: half-yearly [parenteral] vs. daily/weekly/monthly [oral and parenteral], 81 and 38% vs. 21-34 and 10-18%, respectively; parenteral vs. oral, 75 and 36% vs. 32 and 16%; good compliance: half-yearly vs. daily/weekly/monthly, 70 vs. 24-39%; parenteral vs. oral 78 vs. 36%). Good compliance significantly reduced the risks of fracture, fracture-related hospitalization and death (relative risk vs. non-compliance [95% confidence interval]: 0.77 [0.70-0.84], 0.72 [0.62-0.85] and 0.57 [0.51-0.64], respectively; P<0.01). Improving compliance through long-interval parenteral therapies may result in clinical benefits for patients.

A neurológiai kórképek fizioterápiás ellátásának egészségbiztosítási vonatkozásai a járóbetegszakellátásban

The aim of our study is to analyse the ambulatory rehabilitation care of patients with neurological disorders in the field of physiotherapy. Data derive from the database of the Hungarian National Health Insurance Fund Administration (year 2009). The analyses covered patients with diagnosis "G00-G99 Diseases of the nervous system" according to the International Classification of Diseases and underwent physiotherapy treatment. In 2009 altogether 190986 patients with neurological disorders received physiotherapy treatment in outpatient care, representing 1331675 cases and got 388.215 million Hungarian Forint health insurance reimbursement. The number of patients with nerve, nerve root and plexus disorders was 39 patients/10 000 population for males and 66 patients/10000 population for females. The number of patients with cerebral palsy and other paralytic syndromes was 49 patients/10000 population for males and 35 patients/10000 population for females. The number of patients with episodic and paroxysmal disorders was 33 patients/10000 population for males and 52 patients/10000 population for females. In the outpatient physiotherapy care the utilization indicators for female patients were higher in nerve, nerve root and plexus disorders and episodic and paroxysmal disorders, while in cerebral palsy and other paralytic syndromes the utilization by male patients was higher. There are important age and gender inequalities in the utilization of physiotherapy care of patients with neurological disorders.