G. Terrazzani

Evaluation of the prescription and utilization patterns of statins in an Italian local health unit during the period 1994–2003

ObjectivesThe prescription pattern of statins in the Local Health Unit (LHU) of Treviso (northern Italy) over a 10-year period was evaluated, with the aim of evaluating the persistence with and adherence to therapy.MethodsData on 21,393 subjects who received at least one prescription for statins during the period between January 1, 1994 and December 31, 2003 were retrieved from the LHU database in order to track the pharmacological history of individual patients. The data included age, sex, drug formulation, strength, number of drug packages prescribed, and prescription date. The adopted indicators for drug utilization included the Defined Daily Dose (DDD), the Received Daily Dose (RDD), and a surrogated Prescribed Daily Dose (sPDD), extrapolated from available prescription data. An Adherence to Therapy Index (ATI) was calculated from the ratio between the amount of drug actually prescribed and the amount of sPDD. Based on the ATI, patients were grouped into non-adherent, poor-adherent, and good-adherent groups. The distribution of adherence level among patient-age classes and statin-prescribed patients in primary or secondary prevention was evaluated.ResultsAll drug-utilization indicators showed an increase in statin use over the study period in terms of both the number of prescribed patients and the sPDD. Persistence with and adherence to therapy remained low, with a 50% discontinuation rate in the first year, and persistent patients did not follow the therapy regularly. Patients in secondary prevention were the most adherent to their drug regimen, although only 41% of these had a good compliance.ConclusionsOur findings suggest an increase in statin use which is, however, accompanied by poor patient persistence with and adherence to statin therapy.

Benefit of statins in daily practice? A six-year retrospective observational study.

This observational retrospective study analysed the association of adherence to statins with the achievement of a target total cholesterol level (CL, <200mg/dl), and any association of adherence with the time to first hospital admission for coronary event in hypercholesterolemic patients treated with statins, in one Italian Local Health Authority between 1998 and 2003. The study population consisted of 3516 patients who were prescribed statins and for whom full cholesterol results were available. After three months of treatment, there were significant reductions in CL (p<0.001) in the three treatment groups stratified by adherence (good adherents -24%, poor adherents -22%, and nonadherents -14%). Patients more likely to achieve the target CL were older, male and more adherent to the statins. The risk of first hospitalization was associated positively with increased age and male gender. Patients with co-treatments were more likely to be hospitalized. Surprisingly, better adherence to statin treatment increased the risk of hospitalization.

Dieci anni di utilizzo delle statine: adesione alla terapia e costi del trattamento farmacologico

SummaryObjectivesThe beneficial effect of lipid-lowering drugs, in particular of HMG-CoA Reductase Inhibitors (statins), is well established. However, their utilization is often believed to be too low. Our objective was to describe consumption and costs and to investigate compliance with statins treatment in an Italian population.Design, Setting, and PatientsA retrospective cohort study conducted on the Local Health Authority N. 9, Treviso, of statin utilization between 1994 and 2003. For the year 2002, were also assessed patients adherence to prescribed treatments and statins efficacy in lipid lowering.MethodsDemographic and pharmaceutical data were retrieved from the database of pharmaceutical prescriptions and from patients’ registry of the Pharmaceutical Office, Local Health Authority N. 9, Treviso. Patients were stratified in cohorts according to incidence year and first statin prescribed. Prescribed Daily Dose (PDD) was calculated for each statin in order to assess the adherence to the therapy of the patients. Cholesterol data at the beginning of treatment and after 3 months were supplied from the database of laboratory tests of Treviso Hospital.ResultsIn Treviso, the annual spending increased from € 600.000 to about € 4 millions from 1994 to 2003. The PDD in 2002 was 19.8mg for simvastatin, 26.6mg for pravastatin, 66.6mg for fluvastatin, and 13.9mg for atorvastatin. Adherence to therapy was calculated for 1235 patients; we considered non-adherent when less than 50% of statin was prescribed, partially adherent when this percentage rose from 50% to 80% of prescribed drug and adherent when it was at least 80%. According to these criteria, only 42% of incident patients in 2002 was adherent, and only 1/2 of the total statins spending in Treviso was due to adherent patients.In a sample of incidence and adherent patients in 2002 we found a PDD higher than the PDD calculated for all incident patients of that year; patients allocated to fluvastatin seem to have the greatest reduction of total cholesterol (−27.3%).ConclusionsStatins spending has increased dramatically in Treviso in a decade, however statin utilization in a large proportion of patients (non-adherent or partially adherent) is far from being optimal, preventing the potential benefit of the pharmacological treatment.

Le patologie gastrointestinali dall’epidemiologia all’intervento terapeutico nella pratica di medicina generale: analisi dei costi sanitari indotti

SummaryObjectiveTo define the occurrence and costs of medical therapy of GI diseases in a general practice setting and to evaluate the role of general practitioners (GPs) and patients in the prescription of gastrointestinal (GI) drugs.DesignAn observational study conducted from July 1999 to June 2000 in the Treviso area (North-East Italy).MethodsPrescription data were obtained from a questionnaire filled out by randomly recruited GPs. Data were compared with official records of drug utilization and diagnostic/therapeutic procedures provided by the Local Health Authority database, in order to obtain costs and occurrence of all prescriptions. 24 GPs (out of 80 contacted) were asked to fill out a form for each patient with a GI pathology. Inclusion criteria for patients were: age ≥ 18 years; prescription of a drug with ATC code A02AD*, A02BA*, A02BC*, A02BB01, A02BX* or A02FA*. The total number of patients monitored was 27 948 (7.7% of the local population).Main outcome measures and resultsIn the analysed period, the number of patients receiving a GI drug prescription was 1 235 (712 females and 523 males). The number of drug prescriptions was 7 682. The GPs were determinant for all kinds of drug prescription, though specialists and patients also had a role in inducing it. Gastritis and gastroesophageal reflux disease (GERD) were the most frequent GI pathologies, affecting females more often than males. The cost of drug therapy was highest for GERD (€ 252), followed by ulcer (€ 162), gastritis (€ 139), prevention of drug-induced gastric damage (€ 118), while the overall treatment costs were highest for ulcer. When costs of diagnostic and therapeutic treatments of most GI diseases were also considered, PPIs show an economic advantage over H2-receptor antagonists. Only for the prevention of gastric lesions by drugs, the use of prostaglandins was economically more convenient.ConclusionsThe data provide evidence of a peculiar therapeutic attitude in treating GI diseases in the general practice setting. Pharmacoeconomic data point out to a different treatment pattern from the one found in the hospital setting.

Il costo del paziente depresso: l’esperienza della Ulss 9 di Treviso

SummaryObjective: Depression is an increasing common mental disorder associated with significant costs for both patients and health care systems. The aim of this study was to assess the overall direct costs of depression for 2004 in the Local Health Authority n.9 (LHA9), Treviso, Italy. Methods: Data were retrieved from the database of pharmaceutical prescriptions including all prescriptions reimbursed by the National Health Service (NHS). In this retrospective cohort study, patients were enrolled with a depression diagnosis from a psychiatrist (DSM cohort) or treated with one of the following antidepressant drugs: tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRI) and other antidepressants (SFT cohort). If they had any prescription of antidepressant in the previous 2 years they were considered prevalent patients, otherwise they were recognized as incident. Results: Antidepressants were prescribed to 13,984 patients: females and males were the 4.8% and 2.2% of the total population living in LHA9, respectively. The total of direct costs for depressive illness, including drugs (antidepressants and all other drugs), hospital admissions, and laboratory analyses, was € 37,174,107.13, where hospital admissions represented the 42.7%. The cost/year of the SFT cohort for prevalent patients was € 2,438; whereas that of incident patients was € 4,022 vs € 2,792 before and after starting the antidepressant treatment, respectively. The same pattern, but with higher values of cost, was observed in the DMS cohort. Conclusions: Cost/year after the beginning of antidepressant therapy or for prevalent patients was lower than that for incident patients, because the former exhibited a decrease in hospitalization.

Analisi delle prescrizioni farmaceutiche e dei costi del trattamento del carcinoma prostatico nell’ULSS 9 di Treviso

SummaryObjectiveIn Italy, the standard curative treatment for prostate carcinoma with metastases is the androgen suppression therapy (AST). Recently, intermittent AST has been introduced for the treatment of androgen-responsive patients aged > 75 years in order to reduce the toxicity and cost of treatment, as well as to delay tumor progression. The purpose of this study was to perform a cost-analysis of standard AST, intermittent AST or bilateral surgical castration.Patients and settingA total of 584 patients from the ULSS 9 (district of Treviso, Veneto, Italy) treated with AST, examined in 1999.Main outcome measuresParameters adopted in this study were drug prescriptions, length of treatments, biochemical assays and costs of hospital stay.ResultsThe patients exposed to AST represented 0.33% of the whole male population of the district. Two hundred and sixty-one subjects were aged > 75 years. The largest proportion of the treated population was 78 years-old. Eighty patients had been receiving AST for more than 6 years, and during the year 1999 approximately 50% of them were not prostate-specific antigen (PSA)-tested.Cost-analysisThe yearly treatment cost for prostate cancer per patient was € 3,823.46 as assessed in 1999. In order to reduce costs, three scenarios can be considered: a) with the cheapest AST drug (triptorelin, 11.25 mg), the estimated cost would be € 3,495.09 patient/year, b) with surgical castration, the estimated cost would be lower (€ 2,268.98 patient/year), and finally c) treatment with intermittent AST of patients > 75 years, previously treated with AST for at least 1 year, would cost € 2,525.30 patient/year.ConclusionsIn addition to its reduced toxicity, intermittent AST should be extensively considered for use because of the reduced cost of AST therapy, which would be similar to the cost of surgical castration.