Doctors commitment and long-term effectiveness for cost containment policies: lesson learned from biosimilar drugs

Agency is a pervasive feature of the health care market, with doctors acting as agents for both patients and the health care system. In a context of scarce resources, doctors are required to take opportunity cost into account when prescribing treatments, while cost containment policies cannot overlook their active role in determining health care resource allocation. This paper addresses this issue, investigating the effects of cost containment measures in the market of biosimilar drugs that represent a viable and cost-saving strategy for the reduction of health care expenditure. The analysis focuses on a particular region in Italy, where several timely policies to incentivize biosimilar prescribing were launched

Differences in drug use between men and women: An Italian cross sectional study

Background: Drugs are the most important treatment option for most diseases, and the majority of medical consultations result in a prescription. Women and men receive different drug prescriptions and differ in therapeutic response to pharmacological therapy. This disparity is due to biological factors (sex differences) or/and behavior, lifestyle and life experience (gender differences). Sex differences in drug use have been demonstrated in several therapeutic areas; however, there is a lack of overviews on sex and gender differences of drug use in an entire population. Methods: We conducted a descriptive cross - sectional drug use study, involving the entire Italian population in 2012, aimed at showing and analyzing differences between men and women as regards their exposure to drugs. The data source was IMS LifeLink Treatment DynamicsTMLRx Database and it included all prescribed drugs reimbursed by the Italian National Healthcare System in 2012 and covered 90% of the entire Italian population. The information about the prescriptions was stratified by men and women and age. Drug consumption was expressed as DDD/ 1000 ab die. Exposure to drug prescriptions was expressed as period prevalence (the proportion of the population dispensed ≥1 prescription in 2012 per 1000 inhabitants). Differences of prevalence between men and women were expressed as crude and age adjusted risk ratios with 95% CI. Results: Our findings suggested that the largest differences in drug prescriptions regarded drugs affecting bone structure and mineralization (RR 15.9), calcium (RR 8.6) and thyroid therapy (RR 5.4), dispensed more to women than men. Otherwise ACE inhibitors were more commonly used in men. Conclusions: This is the first study exploring difference in drug use between men and women and carried out on the entire Italian population. Our findings showed substantial differences between men and women in term of prevalence of drug prescriptions. Some differences in drug use may be explained by sex differences (variations in disease prevalence and severity, pathophysiology, or by other biological differences), other differences need further investigation to explain the apparent lack of a rational medical explanation for some findings. The findings may subsequently be used to plan future studies to address differences suggesting inequity in treatment approaches

THE USE OF REAL WORLD DATA TO BUILD ECONOMIC MODELS: A CASE STUDY OF OSTEOPOROSIS

Objectives The aim of this study is to analyze healthcare costs of osteoporosis and to build a economic model cost-effectiveness of pharmacological intervents based on real world data Methods The cost analysis was conducted taking each healthcare service into account during the study period (2005-2008). A hypothetical scenario based on the real-life available evidence was constructed. The mean level of adherence to populate the hypothetical scenario of full adherence was set at MPR >80%. The model was built by adding a step value to the real-world adherence of each subject so that the subject shifted to the hypotetical scenario of full adherence. Cost-effectiveness of full adherence compared to real-world adherence was expressed in terms of ICER and the number of fractures avoided was set as an effectiveness unit of measure. Results The mean annual healthcare cost was € 247.44 per not fractured patient and € 1,044.85 per fractured patient. The economic model showed that the average cost of medical treatments in case of optimal adherence per patient/year would increase from € 88.73 in real-world adherence to € 125.52 in full adherence. The rising costs are compensated by a reduction in number of fractures, decreasing by 65%. In this scenario, also the total yearly costs related hospitalizations would decrease from € 319,379 in real-word adherence to € 110,917 in full adherence. The ICER, expressed in terms of cost/fracture avoided equals € 821 (cost that the NHS should invest to avoide a fracture) Conclusions This study demonstrated the potential of the use of existing data sources to evaluate appropriateness of drug use. Drugs cost money to buy, but if we use them in an appropriate way we can also save costs in other areas. In particular enhancing adherence to medication may lead to reductions in the number of patients requiring hospitalization

Additional file 1: of Differences in drug use between men and women: an Italian cross sectional study

Dataset prevalence. Description data: Prevalence data and Risk Ratio. (PDF 11 kb

An Observational Study of MDR Hospital-Acquired Infections and Antibiotic Use during COVID-19 Pandemic: A Call for Antimicrobial Stewardship Programs

The pandemic caused by the COVID-19 virus has required major adjustments to healthcare systems, especially to infection control and antimicrobial stewardship. The objective of this study was to describe the incidence of multidrug-resistant (MDR) hospital-acquired infections (HAIs) and antibiotic consumption during the three waves of COVID-19 and to compare it to the period before the outbreak at Molinette Hospital, located in the City of Health and Sciences, a 1200-bed teaching hospital with surgical, medical, and intensive care units. We demonstrated an increase in MDR infections: particularly in K. pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp), A. baumannii, and MRSA. Fluoroquinolone use showed a significant increasing trend in the pre-COVID period but saw a significant reduction in the COVID period. The use of fourth- and fifth-generation cephalosporins and piperacillin–tazobactam increased at the beginning of the COVID period. Our findings support the need for restoring stewardship and infection control practices, specifically source control, hygiene, and management of invasive devices. In addition, our data reveal the need for improved microbiological diagnosis to guide appropriate treatment and prompt infection control during pandemics. Despite the infection control practices in place during the COVID-19 pandemic, invasive procedures in critically ill patients and poor source control still increase the risk of HAIs caused by MDR organisms