È stato presentato a metà dicembre 2011 il Rapporto OsMed relativo all’uso dei farmaci in Italia nei primi nove mesi del 2011 [1]. I dati forniti dai rapporti OsMed, relativi al consumo di farmaci nella popolazione generale e descritti in termini di spesa, volumi e tipologia, rappresentano un valido indicatore per la valutazione della prevalenza delle patologie nel territorio e il corrispondente uso di farmaci e propongono l’interpretazione dei principali fattori che influenzano la variabilità nella prescrizione. Dal rapporto emerge che la spesa farmaceutica per i farmaci di classe A nel periodo compreso da gennaio a settembre 2011 è stata di circa 9.370 milioni di euro (154,6 euro pro capite), con una riduzione del 3,7% rispetto allo stesso periodo del 2010. Il numero di ricette, di confezioni e di dosi sono invece aumentati dello 0,6%, 0,8% e 1,2% rispettivamente, con un aumento di 11,2 dosi prescritte ogni mille abitanti (965,4 nel 2011 contro 954,2 nel 2010). In generale è stato evidenziato un lieve aumento della quantità di farmaci prescritti (+1%) e una diminuzione dei prezzi (-5,2%).

The objectives of the present study were to calculate the cost of illness of osteoporosis and to assess drug utilization patterns in postmenopausal women after a fracture-related hospitalization. The study subjects were enrolled from a large population-based administrative database. Female patients (age ≥ 65 years) who were hospitalized for a typical osteoporotic fracture between 1/1/2000 and 31/12/2005 were included. Patients were classified as exposed/unexposed to treatment according to the presence/absence of at least one prescription for an osteoporosis-related medication in the 6 months following the discharge date. Treatment adherence was calculated for patients who were exposed to bisphosphonate therapy and was defined as at least 80% of treatment coverage during the follow-up period of 18 months after the discharge date. Hospitalizations, medications, diagnostic tests, laboratory tests and specialist visits during the 18-month follow-up period were collected and classified as osteoporosis-related or non-related to osteoporosis. A total of 12,376 patients were included in the study (mean age ± SD, 79.1 ± 7.5 years), out of which 97.9% (n = 12,110) were hospitalized due to an osteoporosis-related fracture and only 2.1% (n = 266) had general osteoporosis diagnosis. Among the 12,110 women with a fracture, 15.2% (n = 1,845) had a subsequent fracture-related hospitalization (63.8% of the patients had hip fracture). Only 32.3% (n = 4,001) of all included patients was exposed to osteoporosis-related medications and out of those patients exposed to bisphosphonates (n = 860) only 34.2% (n = 294) was adherent to therapy. The average cost per patient was € 4,481, of which € 1,089 was for osteoporosis-related and € 3,392 for non-osteoporosis-related items. The average cost of a matching cohort of patients without hospitalizations for fracture was € 2,339. Among osteoporosis-related costs, 87.0% was due to hospitalizations for subsequent fractures, 1.5% was due to subsquent hospitalizations for osteoporosis, 9.0% was due to medications, 2.5% was due to laboratory or diagnostic/ instrumental tests. Osteoporosis costs after a first hospitalization for fracture were relevant (twice the costs for patients without hospitalizations for fracture), evident in the short run (within the first 24 months following the index fracture) and mostly due to re-hospitalizations for a new typical osteoporotic fracture. This is in mainly relatedto a low exposure to pharmacological therapy and to insufficient treatment adherence. This study and publication were supported by Amgen Dompè and GlaxoSmithKline.

(1) CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna
(2) Sezione di Reumatologia, Dipartimento di Medicina, Università degli Studi di Verona, Verona
(3) Dipartimento di Ortopedia e Riabilitazione, Seconda Università degli Studi di Napoli, Napoli
(4) SOS Dpt Patologia Osteoarticolare, Azienda Sanitaria ULSS 18, Rovigo
(5) Dipartimento di Chirurgia e Odontoiatria, AO San Paolo, Università degli Studi, Milano
(6) Struttura Semplice di Osteoporosi e delle Malattie Metaboliche dell’Osso. U.O. di Ortopedia e Traumatologia, A.O. Ospedale di Treviglio-Caravaggio, Bergamo
(7) Unità Operativa Complessa di Ortopedia e Traumatologia, Fondazione Policlinico Tor Vergata, Università degli Studi di Roma Tor Vergata, Roma
(8) Clinica ortopedica, Università di Sassari, Sassari
(9) UO di Ortopedia e Traumatologia, Ospedale SS Capitanio e Gerosa - Lovere, AO Bolognini, Seriate (MI)
(10) Amgen Dompè, Health Economics & Reimbursement, Milano

Multiple sclerosis (MS) is a chronic autoimmune disease, which affects the central nervous system and is the leading cause of chronic disability in young adults. Especially in the most common form characterized by relapses and remissions (RRMS), MS is a major burden on the NHS and society at a cost of illness per year for Italy estimated at 1.5 billion euros. The DMT (Disease-Modifying Therapies) when used continuously since the diagnosis of the disease have proved effective in reducing the risk of relapses, slowing the progression of the disease, reducing the consumption of health resources, especially hospitalizations, with a significant savings on healthcare costs. High rates of adherence have been associated with DMT not only to improved clinical performance, but also to a significant reduction in costs associated with the consumption of health resources. Because some recent studies have shown that the use of IFNβ-1a IM leads to better adherence to therapy and a significant savings in hospitalizations, outpatient visits, and also on the access to the PS, it is desirable that in Italy the use of IFNβ-1a IM will become ever greater. In this way, we can assume that we can achieve a significant saving in direct health care costs that affect the NHS, as has been observed in some foreign studies in which adherence to treatment was associated with a reduction in the average annual cost per patient between 33 and 65%.

(1) Cattedra di Farmacologia Clinica, Facoltà di Medicina e Chirurgia, Università di Torino

Introduction: prophylaxis with granulocyte colony-stimulating factors (G-CSF) is indicated for reduction in the duration of neutropenia and the incidence of febrile neutropenia in patients treated with cytotoxic chemotherapy for malignancy.
Objective: to evaluate the budgetary impact for the Italian NHS.
Design: a decision-analytic model has been developed to analyze the budget impact from the national health care system perspective. Costs include direct healthcare costs to the public payer of G-CSFs as well as their administration costs and costs of FN-related events. The comparison has been done using prophylaxis with G‑CSF (filgrastim for 11 days, pegfilgrastim, lenograstim for 11 days) and antibiotics.
Patients and participants: The population of interest for the analysis were patients with breast cancer in stage II and III and patients with non-Hodgkin’s lymphoma (NHL).
Main outcome measures and results: for all the three patients group (NHL, Breast II and III), and for all the chemotherapy regimens (CHOP 21 and R-CHOP 21 for NHL, AC-T, TAC and TC for Breast stage II and III) the budget impact analyses shows a cost reduction for the Italian NHS, as a result of an increase of the use of pegfilgrastim.
Conclusions: in Italy, a treatment strategy including pegfilgrastim as either primary or secondary prophylaxis provides value for money.

(1) Oncologia Medica, Ospedale Regionale, Azienda Unità Locale Socio Sanitaria n°9 di Treviso
(2) Amgen Dompè SpA, Italia
(3) CSD Medical Research Srl, Italia