A Citarella

Proton pump inhibitors prescribing following the introduction of generic drugs

Eur J Clin Invest 2012; 42 (10): 1068–1078

Pharmaco-Economic Consequences of Losartan Therapy in Patients Undergoing Diabetic End Stage Renal Disease in EU and USA

Diabetic nephropathy is the most frequent cause of end stage renal disease (ESRD). As ESRD incidence increases continuously, more resources are needed for treatment. The objective was to evaluate the economic impact of losartan added to the standard care administered to diabetic subjects with ESRD. The analysis has involved more than 500 million inhabitants. Standard methods have been used in order to conduct an economic evaluation comparing the economic outcomes deriving from the administration of losartan added to standard care versus standard care alone in patients with type 2 diabetes mellitus (DM) and nephropathy over 3.4 years. The study was hence conducted from the perspective of the third-party payer. The clinical outcome data were based on the results from the Reduction of Endpoints in Non-Insulin Dependent Diabetes Mellitus with the Angiotensin II Antagonist Losartan (RENAAL) trial. Direct medical costs are referred to the purchase costs of losartan and to the costs of hospitalization. The costs were discounted back at an annual rate of 3%. Also sensitivity analysis was performed. The RENAAL study showed that losartan confers strong renal protection in patients with DM and nephropathy. Losartan results into cost saving in all countries considered: 3 602.98€/Italy, 4 531.35€/France, 3 019.66€/Germany, 3 949.50€/Switzer-land, and 3 855.50€/US per patient. Results are not sensitive to both clinical and economic variables. In addition to the medical benefits, this analysis demonstrates the economic relevance of the treatment with losartan in DM patients affected by nephropathy.

Overview sulla scarsa aderenza al trattamento farmacologico nei pazienti schizofrenici e stima del fenomeno a livello delle Regioni italiane

AbstractBackground: Antipsychotic medication is the standard treatment for exacerbations as well as for relapse prevention in patients with schizophrenia. However, despite the effectiveness of antipsychotic drugs has been proven, poor adherence to prescribed antipsychotic regimens remains the most important driver of suboptimal clinical outcomes in this population. Objective: This paper focuses on medication non-adherence in patients with schizophrenia and collects the available epidemiological data. Methods: Retrieval of published literature conducted through a structured search of PubMed limited to years 1980–2010. A combination of the following search terms was used: prevalence, compliance, non-compliance, adherence, non-adherence, antipsychotic, schizophrenia. To estimate the number of non-adherent patients three approaches were used. Results: Five studies were identified and reviewed according to study setting, adherence definition, measurements of medication non-adherence. Taking into account a 26% rate of non-adherence, identified as the base-case, in Italy the number of non-adherent patients was estimated to range between 43,076 and 62,447. A sensitivity analysis was conducted using 41% rate of non-adherence. In this scenario, the number of non-adherent patients was estimated to range between 67,928 and 98,474. Conclusion: A number of strategies have been developed to assess and facilitate adherence to pharmacological treatment. The first critical step is clinicians’ awareness of the scope of the problem and consideration of appropriate strategies to address it.