OBJECTIVES: Lichen planus is a dermatological disease characterized by itchy reddish-purple polygon-shaped skin lesions. The aim of our study was to calculate the annual health insurance treatment cost of lichen planus in Hungary. METHODS: 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 lichen planus were identified with the following codes of the International Classification of Diseases 10threvision: L43. RESULTS: The number of patient underwent outpatient care was 3,013 (59.8 % women and 40.2 % men) with a mean age of 54.90 years (women: 57.56 years; men: 50.94 years). Number of patients admitted to in-patient hospital care was 145 (75.9 % women and 24.1 % men) with a mean age of 61.48 years (women: 64.42 years; men: 52.23 years). For the treatment of patients with lichen planusin 2017 the Hungarian National Health Insurance Fund Administration spent 57.282 million Hungarian Forint (HUF) which equals 185.255 Euro (EUR). Major cost drivers were acute inpatient care (35.6 % of total health insurance costs), outpatient care (28.1 %) and pharmaceuticals (26.8 %). CONCLUSIONS: Lichen planus represent a significant burden for the Hungarian 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: 6.61 years; inpatient: 12.19 years) in the onset of the disease between women and men.

categories were included into the study: outpatient care, in-patient care, CT-MRI, PET, home care, transportation, general practitioner, drugs and medical devices. Migraine were identified with the following codes of the International Classification of Diseases 10th revision: G43-G44. Results: The Hungarian National Health Insurance Fund Administration spent 949.9 million Hungarian Forint (HUF) (4.5 million USD) for the treatment of patients with brain cancer. The annual average expenditure per patient was 6305 HUF (30.3 USD) while the average expenditure per one inhabitant was 95 HUF (0.5 USD). Major cost drivers were primary care/general practitioners (56.8 % of total health insurance costs), outpatient care (19.3 %), pharmaceuticals (11.5 %) and CT/MRI examinations (8.0 %). The number of patients with migraine was 150.4 per 10000 populations. We found the highest patient number in primary care/general practitioners (150662 patients), pharmaceuticals (84426 patients) and outpatient care (74424 patients). ConClusions: Migraine represent a significant burden for the health insurance system. Reimbursement of primary care/general practitioners, outpatient care and pharmaceuticals are the major cost drivers for migraine in Hungary.

Objectives: Acute gout is one of the most painful forms of arthritis. Patients with gout frequently have multiple comorbidities including cardiovascular disease (CVD) and hyperuricaemia is an independent risk factor for CVD. In order to manage the underlying disease process, current British Society for Rheumatology guidelines recommend treat-to-target levels of serum uric acid. Suboptimal management of gout may place a substantial burden on secondary care services. The objective of this study was to evaluate the burden of gout on secondary care services in England. MethOds: Data captured in Hospital Episode Statistics (HES) for 2015/16 was analysed to estimate the number of patients with gout as a primary diagnosis who were managed in secondary care. Data included the number of interventions recorded for this patient cohort. Hospital Resource Group (HRG) tariff prices (2016/17) were used to calculate the associated costs of gout treatment. Results: In total 6,443 patients were admitted with a primary diagnosis of gout, this group accounted for 6,992 spells of which 88% were unplanned non-elective admissions. The average unplanned length of stay was 6.5 days. The main HRGs to which these spells mapped were HD23A and HD23B. The cost of these unplanned spells on the NHS was £10,249,319 (ranging from £30,423 to £227,331 per CCG) with the average cost per patient dependent on the presence and severity of comorbidities. The main co-morbidities being hypertension (49%), atrial fibrillation (22%) and diabetes (21%). Eighty-nine percent of patients with gout in 2011 went on to be admitted for a CVD related primary admission by March 2017, resulting in a further burden on healthcare resources. cOnclusiOns: Gout has a significant burden on hospital care in England. Targeting gout as a metabolic disorder, by treating hyperuricaemia as a risk factor for CVD, may lead to improved management of gout and reduced burden on secondary care services.

Objectives: Acute gout is one of the most painful forms of arthritis. Patients with gout frequently have multiple comorbidities including cardiovascular disease (CVD) and hyperuricaemia is an independent risk factor for CVD. In order to manage the underlying disease process, current British Society for Rheumatology guidelines recommend treat-to-target levels of serum uric acid. Suboptimal management of gout may place a substantial burden on secondary care services. The objective of this study was to evaluate the burden of gout on secondary care services in England. MethOds: Data captured in Hospital Episode Statistics (HES) for 2015/16 was analysed to estimate the number of patients with gout as a primary diagnosis who were managed in secondary care. Data included the number of interventions recorded for this patient cohort. Hospital Resource Group (HRG) tariff prices (2016/17) were used to calculate the associated costs of gout treatment. Results: In total 6,443 patients were admitted with a primary diagnosis of gout, this group accounted for 6,992 spells of which 88% were unplanned non-elective admissions. The average unplanned length of stay was 6.5 days. The main HRGs to which these spells mapped were HD23A and HD23B. The cost of these unplanned spells on the NHS was £10,249,319 (ranging from £30,423 to £227,331 per CCG) with the average cost per patient dependent on the presence and severity of comorbidities. The main co-morbidities being hypertension (49%), atrial fibrillation (22%) and diabetes (21%). Eighty-nine percent of patients with gout in 2011 went on to be admitted for a CVD related primary admission by March 2017, resulting in a further burden on healthcare resources. cOnclusiOns: Gout has a significant burden on hospital care in England. Targeting gout as a metabolic disorder, by treating hyperuricaemia as a risk factor for CVD, may lead to improved management of gout and reduced burden on secondary care services.

Objectives: Characterize conditional reimbursement decisions made by the Finnish Pharmaceutical Pricing Board after the enabling legislation allowing confidential agreements came into force 1 Jan 2017, until the end of March 2019. Methods: Public data on reimbursement decisions were analysed. Trade name level data consisted of accepted reimbursement level, type of agreement, reimbursement limitations and list prices. In addition, preceding rejected applications were identified. Results: There were 25 positive conditional reimbursement decisions on 23 different medicines, of which 12 had been previously rejected, five of them more than once. Three decisions concerned reimbursement extensions, and five special reimbursement. All decisions were based on economic agreement, indicating a discount scheme based on sales value, volume or number of patients. 17 decisions concerned oncological preparations: haematology(4), lung(3), breast(3), prostate(2), ovarian(2), renal(2) and melanoma(1). Their annual treatment cost at list prices ranged from 35,000V (breast) to 150,000V (ovarian). During the period two new oncological medicines (renal, colorectal) were accepted for basic reimbursement without confidential agreement, ranking at the lower end of the cost range. Three decisions concerned diseases with significant number of patients; hypercholesterolemia and migraine. The annual cost of these were significantly lower (6,000V-11,000V), and reimbursed patient populations were considerably restricted. Highest annual cost was for enzyme replacement therapy (hypophosphatasia, 200,000V-1.5 million V). Remaining decisions concerned treatments of cirrhosis (PBC), atopic dermatitis, optic neuropathy (LHON) and polycystic kidney disease (ADPKD), with cost range 20,000V-60,000V. Conclusions: Cancer medicines dominate conditional reimbursement decisions. It seems that conditional reimbursement procedure has made reimbursement possible for significant number of new medicines previously rejected. Interestingly, the data also suggests that for oncological medicines conditional reimbursement is currently the primary route in entering into reimbursement system in Finland. Also, the lack of outcome-based agreements so far is noteworthy.