Socio economic disparities in the appropriateness of disease management of diabetes: results of AEQUITAS study

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Treatment plan comparison in acute and chronic respiratory tract diseases : an observational study of doxophylline vs. theophylline

BACKGROUND: The main objective of this article is to estimate the global cost related to the use of the two drugs (associated drugs, specialist visits, hospital admissions, plasma drug monitoring). METHODS: The drug prescriptions were extracted from the Information System of the Pharmaceutical Prescriptions of the Marche Region for each ATC code in the years 2008-2012 and the number of patients per year and other outcomes measure were obtained. RESULTS: 13,574 patients were treated with theophylline and 19,426 patients with doxophylline. The number of patients treated was approximately 5,000 per year. Co-prescription with other drugs, use of corticosteroids, mean number of visits and hospital admissions (per 100 patients) were lower for doxophylline vs theophylline (1.55vs5.50, 0.3vs0.7, 2.05vs3.73 and 1.57vs3.3 respectively). The annual mean cost per patient was €187.4 for those treated with doxophylline and €513.5 for theophylline. CONCLUSIONS: In our study, doxophylline resulted to be associated with a reduction of the overall cost

Risk of hospitalization for heart failure in patients with type 2 diabetes newly treated with DPP-4 inhibitors or other oral glucose-lowering medications: A retrospective registry study on 127,555 patients from the Nationwide OsMed Health-DB Database

Aims Oral glucose-lowering medications are associated with excess risk of heart failure (HF). Given the absence of comparative data among drug classes, we performed a retrospective study in 32 Health Services of 16 Italian regions accounting for a population of 18 million individuals, to assess the association between HF risk and use of sulphonylureas, DPP-4i, and glitazones. Methods and results We extracted data on patients with type 2 diabetes who initiated treatment with DPP-4i, thiazolidinediones, or sulphonylureas alone or in combination with metformin during an accrual time of 2 years. The endpoint was hospitalization for HF (HHF) occurring after the first 6 months of therapy, and the observation was extended for up to 4 years. A total of 127 555 patients were included, of whom 14.3% were on DPP-4i, 72.5% on sulphonylurea, 13.2% on thiazolidinediones, with average 70.7% being on metformin as combination therapy. Patients in the three groups differed significantly for baseline characteristics: age, sex, Charlson index, concurrent medications, and previous cardiovascular events. During an average 2.6-year follow-up, after adjusting for measured confounders, use of DPP-4i was associated with a reduced risk of HHF compared with sulphonylureas [hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.62-0.97; P = 0.026]. After propensity matching, the analysis was restricted to 39 465 patients, and the use of DPP-4i was still associated with a lower risk of HHF (HR 0.70; 95% CI 0.52-0.94; P = 0.018). Conclusion In a very large observational study, the use of DPP-4i was associated with a reduced risk of HHF when compared with sulphonylureas

Treatment plan comparison in acute and chronic respiratory tract diseases: an observational study of doxophylline vs. theophylline

The main objective of this article is to estimate the global cost related to the use of the two drugs (associated drugs, specialist visits, hospital admissions, plasma drug monitoring)

Effetto dei fabbisogni terapeutici sesso ed età correlati sui costi di prescrizione nella medicina generale: Il modello di analisi ASSET (Age and sex standardised estimates of treatment)

Effect of age and sex related therapeutic needs on general practices\u2019 prescribing cost. The ASSET (Age/Sex Standardised Estimates of Treatment) research model Background: The primary objective of this study was to derive cost comparators for the fourteen Anatomical Therapeutic Chemical (ATC) classes of drugs at first level, based on age-sex related weightings. Our aim was to develop an accurate analysis method of prescribing patterns in general practice and to be able to explain individual variations in prescribing costs based on the age/sex distribution of the population and individual clinical needs. Methods: Individual cost data were collected for 3,175,691 subjects living in three different Italian regions (Lombardy, situated in the North, Marche in the Centre and Basilicata in the South). The observation period was 12 months (September 2004 \u2013 August 2005). Results: The analysis by ATC classes showed large variations in prescribing costs for the different age groups in each of the ATC classes for both sexes, and, in some instances, wide differences in prescribing costs by gender. The largest cost difference between age groups, for both males and females, was seen in drugs for the cardiovascular system. Antibiotics revealed a difference from the general pattern with more prescriptions in the youngest age groups compared to other ATC classes. Large differences between sexes were observed in the older age groups in drugs used for the respiratory system. The ASSET sample was a robust proxy of the actual public spending by ATC, while the therapeutic group age/sex related weightings were unable to explain the large individual variations in individual prescribing costs. Conclusion: The outcomes of this study are apparently discordant with the conclusions of the limited published literature on prescribing analysis in general practice, suggesting that the ability to make more accurate comparisons ofprescribing rates, especially in individual therapeutic groups, should help to provide a more sensitive measure when estimating prescribing costs. The ASSET model confirmed the validity of demographic adjusted models to quantify the impact of ageing population in terms of resources needed to satisfy long term population prescribing needs. The ASSET age/sex weightings of total prescribing costs should be used as a guide, not as the ultimate determinant, for an equitable allocation of prescribing resources in conjunction with historic utilisation and cost dat