National Health Insurance Fund Administration Research Articles

Annual epidemiological and health insurance disease burden of hip osteoarthritis in Hungary based on nationwide data

BackgroundHealth services utilization related to hip osteoarthritis imposes a significant burden on society and health care systems. Our aim was to analyse the epidemiological and health insurance disease burden of hip osteoarthritis in Hungary based on nationwide data.MethodsData were extracted from the nationwide financial database of the National Health Insurance Fund Administration (NHIFA) of Hungary for the year 2018. The analysed data included annual patient numbers, prevalence, and age-standardized prevalence per 100,000 population in outpatient care, health insurance costs calculated for age groups and sexes for all types of care. Patients with hip osteoarthritis were identified using code M16 of the International Classification of Diseases (ICD), 10th revision. Age-standardised prevalence rates were calculated using the European Standard Population 2013 (ESP2013).ResultsBased on patient numbers of outpatient care, the prevalence per 100,000 among males was 1,483.7 patients (1.5%), among females 2,905.5 (2.9%), in total 2,226.2 patients (2.2%). The age-standardised prevalence was 1,734.8 (1.7%) for males and 2,594.8 (2.6%) for females per 100,000 population, for a total of 2,237.6 (2.2%). The prevalence per 100,000 population was higher for women in all age groups. In age group 30–39, 40–49, 50–59, 60–69 and 70 + the overall prevalence was 0.2%, 0.8%, 2.7%, 5.0% and 7.7%, respectively, describing a continuously increasing trend. In 2018, the NHIFA spent 42.31 million EUR on the treatment of hip osteoarthritis. Hip osteoarthritis accounts for 1% of total nationwide health insurance expenditures. 36.8% of costs were attributed to the treatment of male patients, and 63.2% to female patients. Acute inpatient care, outpatient care and chronic and rehabilitation inpatient care were the main cost drivers, accounting for 62.7%, 14.6% and 8.2% of the total health care expenditure for men, and 51.0%, 20.0% and 11.2% for women, respectively. The average annual treatment cost per patient was 3,627 EUR for men and 4,194 EUR for women.ConclusionsThe prevalence of hip osteoarthritis was 1.96 times higher (the age-standardised prevalence was 1.5 times higher) in women compared to men. Acute inpatient care was the major cost driver in the treatment of hip osteoarthritis. The average annual treatment cost per patient was 15.6% higher for women compared to men.

Nationwide Study of Real-World Treatment Patterns and Clinical Outcomes in Patients with Metastatic Urothelial Carcinoma in Hungary.

Data describing real-world treatment patterns in patients with metastatic urothelial carcinoma (mUC) in Central-Eastern Europe are scarce, and data from Hungary have not been published. This retrospective, nationwide, real-world study investigated patient characteristics, treatment patterns, comorbidities, and clinical outcomes in patients with mUC in Hungary. Adults diagnosed with mUC from January 2016 through June2021 were identified using the National Health Insurance Fund Administration database. Overall survival (OS) was estimated using the Kaplan-Meier method. In total, 2523 patients with mUC were identified. Median follow-up was 7.1months. Overall, 50% of patients received an identified systemic anticancer treatment; within this subgroup, first-line treatment was platinum-based chemotherapy (PBC) in 86%, non-PBC in 8%, and immune checkpoint inhibitor (ICI) in 6%. The proportion of patients receiving treatment increased from 41% in 2016 to 59% in 2020, driven by increased use of first-line PBC or first-line ICI treatment. Comorbidities were more common in patients receiving first-line ICI treatment vs PBC or non-PBC and in patients receiving carboplatin + gemcitabine vs cisplatin + gemcitabine. Overall, only 24% received a second-line treatment. Unadjusted median OS from the start of first-line treatment in the PBC, non-PBC, and ICI subgroups was 12.8, 7.5, and 6.3months, respectively. Median OS from date of diagnosis in untreated patients was 7.8months. OS comparisons adjusted for differences in baseline characteristics between subgroups could not be performed. To our knowledge, this is the first study to assess treatment patterns in patients with mUC in clinical practice in Hungary, using the national health insurance database. Rates of first- and second-line treatment were consistent with those observed in other countries. Avelumab first-line maintenance treatment became available for reimbursement in Hungary in late 2022, after the study period. Given the evolving landscape of reimbursed treatments in Hungary, further analyses are warranted.

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.

The development of one-day surgical care in Hungary between 2010 and 2019

BackgroundThe constant increase in the utilization of one-day surgical care could be identified since more than a decade in most of European countries. Initially, according to the international rankings, the exploitation of one-day surgery in Hungary was not really significant. In 2010, the Hungarian policy makers intended to increase one-day surgical care as a priority strategy. The aim of our study was to analyze the evolution of the Hungarian one-day surgical care during the last decade in DRG- based performance financing system in Hungary.MethodsThe dataset of the research was provided by the National Health Insurance Fund Administration of Hungary. The most important indicators related to the one-day surgical care were compared to inpatient care (market share, number of cases, and DRG cost-weights). To discover the impact of one-day surgical care to the utilization of inpatient treatment, the number of hospitalized days was also analyzed.ResultsBetween 2010 and 2019, the market share of one-day surgical cases increased from 42, to 80%. Simultaneously the constant increase of one-day surgical cases, the number of hospitalized days were decreased in inpatient care by 17%. The value of Case Mix Index has also increased, approximately by 140%, which could confirm that more complex interventions are being conducted in one-day surgical care as well.ConclusionsDue to the comprehensive health policy strategy related to the dissemination of one-day surgical care in Hungary, several important performance indicators were improved between 2010 and 2019. Given that Hungary belongs to the low- and middle-income countries, the results of the study could be considerable even in an international comparison.

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.

POSC88 Annual Health Insurance Treatment Cost of Other Cataract Based on Routinely Collected Health Care Financing Data

The high number of patients with other cataract means a significant burden for the society as well. Our aim was to determine the annual health insurance treatment cost of other cataract in Hungary. Data were derived from the financial database of the 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 other cataract were identified with the following code of the International Classification of Diseases 10th revision: H26. In 2018, the Hungarian NHIFA spent more than 3,19 billion Hungarian Forints (HUF) on treatment of patients with other cataract, [11.82 million American Dollars (USD), or 10.02 million Euros (EUR). 38.88% of costs were spent on the treatment of male, while 61.12% on female patients. The highest patient numbers were in use of outpatient care: 22,212 men (35.97%), and 39,545 women (64.03%) in total 61,757 patients. Inpatient care (87.56% of total health insurance costs in men, 85.79% in women), outpatient care (9.78% in men, 11.16% in women) and general practitioner (1.31% in men, 1.42% in women) were the main cost drivers, while all other forms of medical care amounted to 1.34% in men and 1.64% in women. Annual health care treatment cost per patient was 55,950 HUF (207 USD/175 EUR) in men and 49,411 HUF (183 USD/155 EUR) in women. Inpatient care was the major cost driver in the treatment of other cataract primarily. Major cost drivers showed a moderate difference between men and women. The average annual health insurance costs per patient was 13% higher among men.

Assessing the epidemiological disease burden and health insurance treatment cost of diabetic polyneuropathy based on health insurance claims data

Neurological complications are the most common type of complications among type 2 diabetes mellitus patients, which put a heavy burden on both individuals and health insurance organizations. The aim of our study was to determine the epidemiological and health insurance disease burden of non-insulin-dependent diabetes with neurological complications. Data were derived from the financial database of the National Health Insurance Fund Administration (NHIFA) of Hungary for the year 2018. Data analysed included annual patient numbers and prevalence of care utilisation per 100000 population according to age groups and sex. Patients were identified with the following code of the International Classification of Diseases, 10th revision: G6320. In 2018, NHIFA spent 6.63 billion HUF (24.52 million USD; 20.78 million EUR) on treating diabetic polyneuropathy. Reimbursement of pharmaceuticals was the main cost driver (78.29% of total expenditure). Based on patient numbers in outpatient care, prevalence in 100000 population was 862 men, 981 women, together 924 people based on outpatient-care utilization. Most patients were aged between 65-74 years in all forms of care. Regarding sex, no significant differences were found among most age groups, however, the ratio of women tends to be higher above 65 years of age. Prevalence was found to be by 15.6% higher among women. Significantly higher patient numbers were found in old age. Besides therapeutic interventions, prevention should gain considerably more attention to avoid polyneuropathic complications. Orv Hetil. 2021; 162(Suppl 1): 38-45.

PNS107 The Importance of Innovative Financing and Earmarked Taxes in Health Care - the Case of Hungary

Resource scarcity is an important issue of health care systems worldwide. WHO highlighted the importance of having earmarked revenues for sustainability of health systems. Our aim is to show examples of possible innovative financing by earmarking certain taxes and revenues in Hungary. A retrospective, descriptive study was conducted by analysing nationwide data from the National Health Insurance Fund Administration of Hungary. Amount of income and its share of the Health Insurance Fund (HIF) were assessed of the following revenue sources: health contribution (subsidy on incomes that are otherwise not levied for health); payment of medicament producers and distributors; accident tax (paid by vehicle operators to cover for health expenditures due to road accidents); public health product tax (PHPT, upon unhealthy food, beverages and certain alcoholic drinks) and the health contribution of tobacco companies in 2015. Period of 1997-2018 were analysed. Health contributions gave 14.45% of all income in 1997, it reached its highest in 2000 (24.71%) since then its decreasing (2018: 7.44%). Medicament producers/distributors pay their contribution since 2003, which grew from 6.3 billion HUF (17.67 million EUR; 0.61% of HIF) to 88.2 billion HUF (247.35 million EUR; 3,75%) by 2018. Although accident tax was in force in 2012-2019 only, its income increased by 72.3% (43.3 billion HUF, 121.43 million EUR; 1.84%) during this time. PHPT is imposed on unhealthy food/beverages since 2011, and on alcoholic drinks since 2015, it brought 40.6 billion HUF (113.86 million EUR; 1.73%) in 2018. PHPT has a uniquely wide range of products and became a stable, reliable source for health care, while other earmarked taxes could not persist (e.g. accident tax, contribution of tobacco companies). Earmarking taxes of products or services that - even indirectly - affect health care should be optimized for the sake of long-term sustainability.

Cost-effectiveness analysis of invasive EEG monitoring in drug-resistant epilepsy

PurposeOur aim was to determine the cost-effectiveness of two intracranial electroencephalography (iEEG) interventions: 1) stereoelectroencephalography (SEEG) and 2) placement of subdural grid electrodes (SDGs) both followed by resective surgery in patients with drug-resistant, partial-onset epilepsy, compared with medical management (MM) in Hungary from payer's perspective. MethodsThe incremental health gains and costs of iEEG interventions have been determined with a combination of a decision tree and prevalence Markov process model over a 30-year time horizon in a cost–utility analysis (CUA). To address the effect of parameter uncertainty on the incremental cost-effectiveness ratio (ICER), deterministic and probabilistic sensitivity analyses were performed. ResultsOur results showed that both SEEG and SDG interventions represent a more expensive but more effective strategy than MM representing the current standard of care. The total discounted cost of SEEG and SDG were € 32,760 and € 25,028 representing € 18,108 and € 10,375 additional cost compared with MM, respectively. However, they provide an additional 3.931 (in SEEG group) and 3.444 quality-adjusted life years (QALYs; in SDG group), correspondingly. Thus, the ICER of SEEG is € 4607 per QALY gain, while the ICER for SDG is € 3013 per QALY gain, compared with MM. At a cost-effectiveness threshold of € 41,058 per QALY in Hungary, both subtypes of iEEG interventions are cost-effective and provide good value for money. SignificanceBecause of the high cost of implanting electrodes and monitoring, the invasive EEG for patients with refractory epilepsy is currently not available in the Hungarian national healthcare system. Our study demonstrated that these procedures in Hungary are cost-effective compared with the MM. As a result, the introduction of iEEG interventions to the reimbursement list of the National Health Insurance Fund Administration was initiated.

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.

PNS217 DRG PORTFOLIO ANALYSIS OF THE STATE FUNDED HUNGARIAN WAITING-LIST REDUCTION PROGRAM

Waiting lists are subject to significant interest in many countries. The waiting-list system in Hungary is fairly transparent. In 2015, the National Health Insurance Fund Administration of Hungary established a waiting-list reduction program with the aim to significantly shorten waiting-lists and waiting times. The aim of the study is to analyze the Diagnosis Related Groups (DRG) portfolio of the waiting list reduction program between 2015-2018. The database of the research contained all of the public-funded cases between 2015-2018, which were financed in the Hungarian waiting-list reduction program, especially the name and the type of the responsible institutes, as well as the name and code of DRGs. The database was provided by the National Health Insurance Fund Administration of Hungary. Between 2015-2018, 24,093 cases were financed in the Hungarian waiting list reduction program. Most of the cases were provided by county hospitals (number of cases: 7,562). According to the DRG main groups, the “eye diseases” (02P; market share= 46.06%) and the “musculoskeletal and connective tissue diseases “(08P; market share= 35.82%) were the most significant among the financed waiting-list cases. The cataract surgery using phacoemulsification with a curved lens implant (DRG: 0680) was the most performed DRG (number of cases=10,963), although the implantation of bicondylar knee joint (DRG: 371E) was also remarkable (number of cases=3,865). The market share of the 10 most performed DRG was 92.49% from all financed DRG. More than 80 DRG was funded in the Hungarian waiting-list reduction program, although there were a significant disbalance among them. The number of cases linked to the cataract waiting- list were remarkable, however cases linked to the hip and knee arthroplasty were also noteworthy.

PNS116 TERRITORIAL DISTRIBUTION OF CASE NUMBERS RELATED TO THE HUNGARIAN WAITING- LIST REDUCTION PROGRAM BETWEEN 2015-2018

Waiting lists are subject to interest throughout the world. The National Health Insurance Fund Administration established a waiting list reduction program in 2015 with the aim to significantly shorten waiting list cases and waiting times. The goal of the study is to analyze the territorial distribution of cases within the waiting list reduction program. The database covered the period of 2015-2018, and contained all public-funded cases, which were financed in the above-mentioned program. The database also contained information about the patients’ place of residence, the localization of responsible healthcare institutes, as well as the distance between the responsible hospitals and the patients’ place of residence. The database was provided by the National Health Insurance Fund Administration of Hungary, and the Hungarian Central Statistical Office. For the statistical analyzes and the geographical representations the Microsoft Excel and the Quantum GIS software were used. Between 2015-2018. 24,771 cases were financed within the waiting-list reduction program in Hungary. In most cases the patient was female (63%). Nationwide 77% of the cases were treated in the patients’ county of residence (19,064 cases). Among the counties, this rate was the highest in Baranya county (97%), and the lowest in Pest county (3%). Between 2015-2018, the number of cases reflected to 10,000 inhabitants was the highest in Baranya county (19.41) and the lowest in Hajdú-Bihar county (0.95), while the national average was 6.14 cases. The average travel-distance of the patients was 136.32 kilometers in those cases which were treated outside of the patients’ county of residence (5,707 cases). The majority of cases were treated in patients’ county of residence. Those interventions which were performed outside of the patients’ county of residence mostly linked at Budapest’s hospitals.

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.

PND18 ANNUAL HEALTH INSURANCE TREATMENT COST OF SLEEP APNOEA BASED ON ROUTINELY COLLECTED FINANCING DATA

Sleep apnoea is a significant burden for both the individual and society. Our aim was to determine the annual health insurance treatment cost of sleep apnoea in Hungary. The 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, drugs and medical aids. Patients with sleep apnoea were identified with the following code of the International Classification of Diseases 10th revision: G4730. In 2018, the Hungarian National Health Insurance Fund Administration spent 776.37 million Hungarian Forints (HUF) for the treatment of patients with sleep apnoea [2.87 million American Dollars (USD), or 2.43 million Euros (EUR)]. 78.0% of costs was spent on the treatment of male, while 22.0% on female patients. The highest patient numbers were in outpatient care: 13,752 men (72.5%), and 5,204 women (27.5%) in total 18,956 patients. Medical aids (68.9% of total health insurance costs in men and 56.7% in women), outpatient care (26.2% in men and 34.3% in women) and acute inpatient care (1.9% in men and 3.2% in women) were the main cost drivers, while all other forms of medical care amounted to 3.0% in men and 3.7% in women. Annual health care treatment cost per patient was 44,030 HUF (163 USD/138 EUR) in men and 32,835 HUF (121 USD/103 EUR) in women. Medical aids proved to be the major cost driver. Major cost drivers in the treatment of sleep apnoea, however, showed a difference between men and women. The average annual health insurance costs per patient was 34% higher in men.

PRS35 ANNUAL HEALTH INSURANCE TREATMENT COST OF ASTHMA BASED ON ROUTINELY COLLECTED FINANCING DATA

Developed countries have seen an increase in the prevalence of asthma. The treatment of its main symptoms and its increasing prevalence have become major challenges for health care financers and governments. Our aim was to determine the annual health insurance treatment cost of asthma 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 allergic asthma were identified with the following code of the International Classification of Diseases 10th revision: J4590. In 2018, the Hungarian National Health Insurance Fund Administration spent 11.79 billion Hungarian Forints (HUF) on the treatment of asthma patients, 43.62 million American Dollars (USD), or 36.97 million Euros (EUR). 40.13% of costs was spent on treatment of male, 59.87% on female patients. The highest patient numbers were in general practice care: 140,737 men (42.78%), 188,275 women (57.22%), in total 329,012 patients. Pharmaceuticals (60.32% of total health insurance costs in men, 60.92% in women), outpatient care (16.17% in men, 15.88% in women) and general practice care (9.19% in men, 8.86% in women) were the main cost drivers, all other forms of medical care amounted to 14.32% in men and 14.34% in women. Annual health care treatment cost per patient was 33,614 HUF (124 USD/105 EUR) in men and 37,482 HUF (139 USD/118 EUR) in women. Pharmaceuticals were the major cost drivers in the treatment of asthma. Major cost drivers showed no significant difference between the sexes. The average annual health insurance costs per patient was 12% higher in women.