title: Cost-consequence analysis of cause of death investigation in Finland and in Denmark.
abstract: The 1990s 12-16% total autopsy rate in Denmark has until now declined to 4%, while in Finland, it has remained between 25 and 30%. The decision to proceed with a forensic autopsy is based on national legislation, but it can be assumed that the financing of autopsies influences the decision process. Only little is known about the possible differences between health economics of Finnish and Danish cause of death investigation systems. The aims of this article were to analyse costs and consequences of Finnish and Danish cause of death investigations, and to develop an alternative autopsy practice in Denmark with another cost profile. Data on cause of death investigation systems and costs were derived from Departments of Forensic Medicine, Departments of Pathology, and the National Police. Finnish and Danish autopsy rates were calculated in unnatural (accident, suicide, homicide and undetermined intent) and natural (disease) deaths, and used to develop an alternative autopsy practice in Denmark. Consequences for society were analysed. The estimated unit cost (€) for one forensic autopsy is 3.2 times lower in Finland than in Denmark (€1400 versus €4420), but in Finland the salaries for forensic pathologists working at the National Institute for Health and Welfare are not included in the unit cost. The unit cost for one medical autopsy is also lower in Finland than in Denmark; €700 versus €1070. In our alternative practice in Denmark, the forensic autopsy rate was increased from 2.2% to 8.5%, and the medical autopsy rate from 2.4% to 5.8%. Costs per 10,000 deaths were estimated to be 50% (±25%) higher than now; i.e. €3,678,724 (2,759,112-4,598,336), but would result in a lower unit cost for forensic autopsies €3,094 (2,320-3,868) and for medical autopsies €749 (562-936). This practice would produce a higher accuracy of national mortality statistics, which, consequently, would entail higher quality in public health, an accurate basis for decision-making in health politics, and better legislative safety in society. The implementation of this alternative practice in Denmark requires that legislation demands that forensic autopsy be performed if causality between unnatural death and cause of death cannot be clarified or if cause of death remains unknown. The Danish Health and Medicines Authority should provide guidelines that request a medical autopsy in natural deaths where more information about disease as a cause of death is needed. Our study results warrant similar health economic analyses of different cause of death investigations in other countries.
authors.affiliation: Department of Forensic Medicine, Aarhus University, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark.
authors.forename: Seija
authors.initials: S
authors.lastname: Ylijoki-Sørensen
authors.affiliation: ADBOU, Institute of Forensic Medicine, University of Southern Denmark, Lucernemarken 20, 5260 Odense S, Denmark. Electronic address: jboldsen@health.sdu.dk.
authors.forename: Jesper Lier
authors.initials: JL
authors.lastname: Boldsen
authors.affiliation: National Institute for Health and Welfare, Forensic Medicine Unit, Helsinki Kytösuontie 11, 00300 Helsinki, Finland. Electronic address: kaisa.lalu@thl.fi.
authors.forename: Kaisa
authors.initials: K
authors.lastname: Lalu
authors.affiliation: Department of Forensic Medicine, Hjelt Institute, Helsinki University, Kytösuontie 11, 00014 Helsinki, Finland, and Institute of Applied Genetics, Department of Molecular and Medical Genetics, University of North Texas Health Science Center, Ft. Worth, Texas, USA. Electronic address: antti.sajantila@helsinki.fi.
authors.forename: Antti
authors.initials: A
authors.lastname: Sajantila
authors.affiliation: Centre for Clinical Research, Vendsyssel Hospital/Faculty of Medicine, Aalborg University, Bispensgade 37, 9800 Hjørring, Denmark. Electronic address: utb@dcm.aau.dk.
authors.forename: Ulrik
authors.initials: U
authors.lastname: Baandrup
authors.affiliation: Department of Forensic Medicine, Aarhus University, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark. Electronic address: lwb@retsmedicin.au.dk.
authors.forename: Lene Warner Thorup
authors.initials: LW
authors.lastname: Boel
authors.affiliation: Department of Business and Management, Danish Center for Healthcare Improvements, Faculty of Social Sciences, Aalborg University, Fibigerstræde 11, Room 73, 9220 Aalborg, Denmark. Electronic address: lehlers@business.aau.dk.
authors.forename: Lars Holger
authors.initials: LH
authors.lastname: Ehlers
authors.affiliation: Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 3-209, 9220 Aalborg, Denmark. Electronic address: boggild@hst.aau.dk.
authors.forename: Henrik
authors.initials: H
authors.lastname: Bøggild
mesh_terms: D001344:Autopsy / Q000191:economics* / Q000706:statistics & numerical data*; D002423:Cause of Death; D003362:Cost-Benefit Analysis; D003718:Denmark; D005387:Finland; D049429:Forensic Pathology / Q000191:economics*; D006801:Humans; D009026:Mortality; D000078329:Workforce
keywords: Autopsy rate; Cause of death; Cost-consequence analysis; Denmark; Finland; Manner of death