1,721,017 research outputs found
LA SPESA FARMACEUTICA TERRITORIALE NELLE AZIENDE SANITARIE LOCALI: INDICATORI PER IL CONTROLLO E PER L'ALLOCAZIONE DELLE RISORSE
No full textDespite the territorial pharmaceutical expenditure represents only about the 15% of the
health expenditure, some features, as the high increase, the supply containment policies
(even in the short period), the variability as to the volume of the services supplied, make
it the cost item where the health managers focus there attention on. Such importance has
gone growing during the last years due to two main groups of factors: the ones,
demographic, scientific and epidemiological, which made its volume growing, the
others, administrative and financial, which tried to restrain its growing due to the
slowdown of the public resources. The Local Health Units (LHU) of the National
Health Service, whose financial balances are under their responsibility according to the
legislative decree 502/92, developed and begun to use some control indicators to
guarantee a correct management of the pharmaceutical expenditure, a correct allocation
of the resources available and a support for the managers decisions. Mostly, such
indicators have been used for the drugs use assessment (in pieces and value), on the
short period (one financial year) and threshold survey fields (pharmaceutical
department). Nevertheless, do not assess the therapeutic practice (drugs use) and
outcomes connected to the different therapeutic solutions (population health) caused
some criticality, as the absence of a control system between applied and indicated
processes (analysis of the variance as regards the therapeutic indications of efficacy and
cost-efficacy of the drugs therapy) and the inducement to a change towards a control of
the consumers rather than towards an increase of therapeutic appropriateness. The
absence of a complete indicators system caused a situation of allocative inefficiency, as
the same amount of resources available should have been used alternatively producing a
better clinical and economic result, and this reduced the control of the LHU towards the
several actors who wheel around the territorial pharmaceutical expenditure with
different objectives. The project of this thesis was the investigation of the Ferrara LHU case which can give to this research results the generalization to an enough wide sample
of health structures, as regards its demographic, social and consumer structure, as well
as its business management and its control system. The project was carried out by the
ratification of a “second level” control indicators package, in addition to those present,
by the arrangement of information technologies and data processing methods, by the
cooperation with the stakeholders charged by the LHU of the outcomes assessment. The
project of this thesis, called ALARM project (Adherence to Long-term therapies:
Assessment and Real practice Management), started on 2004, was renewed till 2010
with the cooperation of Centro di Ricerca in Economia e Management della Salute
(CRISAL) of the Univerity of Ferrara, LHU of Ferrara, Ferrara Hospital, Azienda delle
Farmacie Municipalizzate (AFM) of Ferrara, AstraZeneca Italia S.p.A. and Pfizer Italia
S.p.A. The results of the study were object of presentations at several national and
international congresses
Raggiungimento del target terapeutico nei soggetti avviati al trattamento con statine in pratica clinica. Risultati dallo studio STAR (Statins Target Assessment in Real practice)
No full textThe primary aim of the STAR Study (Statins Target Assessment in Real practice) was to determine the LDL-cholesterol reduction and to analyse patient's and therapeutic factors associated to LDL-cholesterol target attainment in newly treated subjects with statins in an unselected population in clinical practice setting. Administrative databases (including pharmaceutical prescriptions and hospital admissions) and laboratory test databases (including LDL-cholesterol values) of five local health units, distributed in Emilia Romagna, Toscana and Umbria, were linked. A retrospective cohort study was conducted and all subjects aged > or =18 years with a first prescription for statins (newly treated subjects) between January 1st, 2007 and June 30th, 2008 were included. All statin prescriptions over a 12 months follow-up period were considered and used to calculate adherence to treatment. Baseline and follow-up LDL-cholesterol, respectively, were defined according to the nearest determination to the first prescription for statins and to the end of the follow-up period. A total of 3.232 subjects was included, 1.516 males (47%) and 1.716 females (53%), with an average age equal to 65.9 +/- 11.3 years. Among included subjects, 22.,6% had a gap to LDL-cholesterol target or =50%, 30-49%, and 10-29%, respectively, LDL-cholesterol target was attained by 7.1%, 41.8%, and 62.% of subjects. LDL-cholesterol target attainment was associated to gap to target, adherence with treatment, and type of statin
A real-world analysis of adherence, biochemical outcomes, and healthcare costs in patients treated with rosuvastatin/ezetimibe as single-pill combination vs. free combination in Italy
No full textAims: To compare medication adherence, lipid goal attainment, and healthcare costs between patients receiving a single-pill combination (SPC) vs. a free combination treatment (FCT) of rosuvastatin/ezetimibe (ROS/EZE) in Italy. Methods and results: Administrative databases of healthcare entities covering ∼7 million individuals were used to identify adults prescribed with ROS/EZE as SPC or FCT between January 2018 and June 2020. Adherence was calculated as the proportion of days covered (PDC) after cohort balancing by propensity score matching. Patients with available LDL cholesterol testing were assessed for the proportion of those who at baseline were above lipid targets recommended by ESC/EAS Guidelines for their cardiovascular risk category and reached the target during follow-up. Among 25 886 patients on SPC and 7309 on FCT, adherent patients were more represented in SPC than FCT cohort (56.8 vs. 44.5%, P < 0.001), and this difference remained significant (P < 0.001) after stratification by cardiovascular risk (very high, high, and other). The proportion of patients reaching LDL cholesterol target at 1 year follow-up was significantly (P < 0.001) higher in SPC vs. FCT cohort: 35.4 vs. 23.8% for very high cardiovascular risk, 46.9 vs. 23.1% for high risk and 71.6 vs. 49.5% for other risk. Total healthcare costs per patient at 1 year follow-up were lower in SPC vs. FCT users (2337€ vs. 1890€, P < 0.001). In both cohorts, costs were mainly driven by drug expenses and hospitalizations. Conclusion: This real-world analysis in dyslipidaemic patients found that treatment with ROS/EZE as SPC resulted in better adherence, higher chances of reaching lipid goals, and cost savings over FCT, in all cardiovascular risk categories
[The therapeutic management and economic burden of patients with chronic kidney disease non-dialysis-dependent with anemia and ESA treated: findings from a real-world study in Italy]
No full textBackground. L’obiettivo dell’analisi real-world è stato valutare le caratteristiche dei pazienti con insufficienza renale cronica non dipendente da dialisi (IRC-NDD) con anemia e trattati con agenti stimolanti l’eritropoiesi (ESA), analizzarne la farmaco-utilizzazione e il carico economico in pratica clinica italiana. Metodi. È stata eseguita un’analisi retrospettiva basata su database amministrativi e di laboratorio riguardanti circa 1,5 milioni di assistibili. Sono stati identificati pazienti adulti con record identificanti l’IRC-NDD stadio 3a-5 e anemia nel periodo 2014-2016. Sono stati inclusi i pazienti eleggibili agli ESA (presenza di ≥ 2 valori di Hb < 11 g/dL in 6 mesi) attualmente trattati. Risultati. Dei 101.143 pazienti IRC-NDD identificati, 40.020 presentavano anemia. Complessivamente, 25.360 pazienti anemici erano eleggibili al trattamento con ESA e 3.238 (12,8%) attualmente in trattamento sono stati inclusi. L’età media era di 76,9 anni, il 51,1% era di sesso maschile. Le comorbilità più frequentemente riscontrate riguardavano l’ipertensione (> 90% in ogni stadio), il diabete (37,8- 43,2%) e le patologie cardiovascolari (20,5-28,9%). L’aderenza agli ESA è stata osservata nel 47,9% dei pazienti, con una tendenza decrescente dal 65,8% (stadio 3a) al 35% (stadio 5). Una quota consistente di pazienti non presentava visite nefrologiche durante i 2 anni di follow-up. La voce di costo maggiormente impattante era quella relativa ai farmaci (€4.391), seguita dai ricoveri per tutte le cause (€3.591) e dagli esami di laboratorio (€1.460). Conclusioni. I risultati hanno evidenziato un’aderenza non ottimale agli ESA, con un trend di sotto utilizzo di queste terapie nella gestione dell’anemia nell’IRC-NDD. Inoltre, l’analisi ha mostrato un elevato carico economico per i pazienti anemici IRC-NDD.Background. This real-world study aimed to provide insights on the characteristics, drug utilization, and economic burden of chronic kidney disease non-dialysis-dependent (NDD-CKD) patients with anemia prescribed Erythropoiesis Stimulating Agents (ESA) in Italian clinical practice settings. Methods. A retrospective analysis was performed based on administrative and laboratory databases covering around 1.5 million subjects across Italy. Adult patients with a record for NDD-CKD stage 3a-5 and anemia during 2014-2016 were identified. Eligibility to ESA was defined as the presence of ≥ 2 records of Hb < 11 g/dL over 6 months, and patients eligible and currently treated with ESA were included. Results. Overall, 101,143 NDD-CKD patients were screened for inclusion, of which 40,020 were anemic. A total of 25,360 anemic patients were eligible to ESA treatment and 3,238 (12.8%) were prescribed ESA and included. The mean age was 76.9 years and 51.1% was male. More frequently observed comorbidities were hypertension (over 90% in each stage), followed by diabetes (37.8-43.2%) and cardiovascular condition (20.5-28.9%). Adherence to ESA was observed in 47.9% of patients, with a downward trend while progressing across stages (from 65.8% stage 3a to 35% stage 5). A consistent proportion of patients did not have nephrology visits during the 2 years of follow-up. Costs were mainly due to all drugs (€4,391) followed by all-cause hospitalization (€3,591) and laboratory tests (€1,460). Conclusions. Findings from the study highlight an under-use of ESA in the management of anemia in NDD-CKD as well as a sub-optimal adherence to ESA and showed a great economic burden for anemic NDD-CKD patients
Prevalence, incidence, and treatment of anaemia in patients with non-dialysis-dependent chronic kidney disease: findings from a retrospective real-world study in Italy
No full textBackground Limited data are available on the epidemiology and clinical management of anaemia in patients with nondialysis-dependent chronic kidney disease (NDD-CKD).Methods This retrospective observational study was based on records from databases of five Local Health Units across Italy. Adults with reported NDD-CKD stage 3a-5 between 1 January 2014 and 31 December 2016 were identified. Annual prevalence and incidence of anaemia (age- and sex-standardised) and clinical management (erythropoiesis-stimulating agents [ESAs], intravenous [IV] iron, and blood transfusions) were evaluated. Eligibility for ESAs was defined by >= 2 records of Hb < 10 g/dL, or <11 g/dL over 6 months.Results Overall, 101,143 individuals with NDD-CKD (3a-5) recorded between 2014 and 2016 were identified, of whom 40,020 (39.6%) were anaemic. Prevalence of anaemia was 33.8% in 2016 and incidence of anaemia was stable (11.4-12.4%) from 2014 to 2016. Prevalence and incidence of anaemia increased with CKD stage. Among eligible patients, 12.8% with Hb < 11 g/dL and 15.5% with Hb < 10 g/dL received ESAs, and the proportion treated increased with CKD stage. Among ESA-treated patients with at least 2 years of follow up, 18.4% and 19.3% received IV iron in the Hb < 11 and < 10 g/dL groups, respectively, and 16.5% and 19.4% received blood transfusions. Corresponding proportions for the overall anaemic cohort were 9.0% and 11.3%, respectively.Conclusions Anaemia is a significant issue in patients with NDD-CKD. Low rates of ESA treatment indicate a potential treatment gap and suggest that anaemia may not be adequately controlled in many patients.[GRAPHICS]
A Retrospective Observational Real-Word Analysis of the Adherence, Healthcare Resource Consumption and Costs in Patients Treated with Bisoprolol/Perindopril as Single-Pill or Free Combination
No full textIntroduction: The present real-world analysis aims to compare the drug utilization, hospitalizations and direct healthcare costs related to the use of single-pill combination (SPC) or free-equivalent combination (FEC) of perindopril and bisoprolol (PER/BIS) in a large Italian population.Methods: This observational retrospective analysis was based on administrative databases covering approximately 7 million subjects across Italy. All adult subjects receiving PER/BIS as SPC or FEC between January 2017-June 2020 were included. Subjects were followed for 1 year after the first prescription of PER/BIS as FEC (+/- 1 month) or SPC. Before comparing the SPC and FEC cohorts, propensity score matching (PSM) was applied to balance the baseline characteristics. Drug utilization was investigated as adherence (defined by the proportion of days covered, PDC) and persistence (evaluated by Kaplan-Meier curves). Hospitalizations and mean annual direct healthcare costs (due to drug prescriptions, hospitalizations and use of outpatient services) were analyzed during follow-up.Results: The original cohort included 11,440 and 6521 patients taking the SPC and FEC PER/BIS combination, respectively. After PSM, two balanced SPC and FEC cohorts of 4688 patients were obtained (mean age 70 years, approximately 50% male, 24% in secondary prevention). The proportion of adherent patients (PDC >= 80%) was higher for those on SPC (45.5%) than those on FEC (38.6%), p < 0.001. The PER/BIS combination was discontinued by 35.8% of patients in the SPC cohort and 41.7% in the FEC cohort (p < 0.001). The SPC cohort had fewer cardiovascular (CV) hospitalizations (5.3%) than the free-combination cohort (7.4%), p < 0.001. Mean annual total healthcare costs were lower in the SPC (1999euro) than in the FEC (2359euro) cohort (p < 0.001).Conclusion: In a real-world setting, patients treated with PER/BIS SPC showed higher adherence, lower risk of drug discontinuation, reduced risk of CV hospitalization, and lower healthcare costs than those on FEC of the same drugs
Use of antiosteoporotic drugs and calcium/vitamin D in patients with fragility fractures: impact on re-fracture and mortality risk
No full textTo evaluate the impact of pharmacological treatment in osteoporosis patients with recent fracture and to assess the incidence of subsequent fracture and all-cause mortality
Prescribing pattern and resource utilization of monoamine oxidase-B inhibitors in Parkinson treatment: comparison between rasagiline and selegiline
No full textDifferential Adherence to Free and Single-Pill Combination of Rosuvastatin/Ezetimibe: Findings from a Real-World Analysis in Italy
Full text linkIntroduction: Adherence to cardiovascular drug treatment can significantly benefit from a reduced pill burden, but data on this matter derived from real-life settings are currently scanty. This analysis assessed the possible changes in adherence in patients treated with rosuvastatin and ezetimibe (ROS/EZE) as free multi-pill combination who switched to ROS/EZE as single-pill combination in the setting of real clinical practice in Italy. Methods: A retrospective analysis was conducted on the administrative databases for a catchment area of about seven million health-assisted residents. Adults receiving ROS/EZE as a single-pill combination from January 2010 to June 2020 (followed up to 2021) were identified. The date of the first prescription of single-pill combination of ROS/EZE was considered as the index date. The analysis included the users of ROS/EZE as a free combination during the year before the index date. Baseline demographic and clinical characteristics were collected during the period of data availability prior to the index date. Adherence to therapy was evaluated as proportion of days covered (PDC), namely the percentage of days during which a patient had access to medication, in the 12-month interval preceding or following the index date (PDC 75% adherence). Results: A total of 1219 patients (61.1% male, aged 66.2 +/- 10.4 years) were included. Cardiovascular comorbidities were found in 83.3% of them, diabetes in 26.4%, and a combination of both in 16.2%. Single-pill combination of ROS/EZE was associated with a higher proportion of adherent patients compared to free-pill combination (75.2% vs 51.8%, p < 0.001). Conclusions: This real-world analysis suggested that switching from a regimen based on separate pills to one based on a single-pill combination resulted in improved adherence to ROS/EZE therapy
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