Despite 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