Paola Deambrosis

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.

Cost-of-illness study of diabetes mellitus: focus on patients with type 2 diabetes

ObjectiveThe aim of the study was to assess the cost of management of diabetic patients; moreover, for type 2 not insulin-dependent patients, also the durability of treatments was evaluated, in ord...

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.

Real-practice thromboprophylaxis in atrial fibrillation

Abstract This retrospective observational study was based on databases of the Local Health Authority of Treviso, Italy. It evaluated the prevalence and the effectiveness of oral anticoagulation treatment (OAT) for the management of nonvalvular atrial fibrillation (NVAF) in everyday clinical practice. Out of 6,138 NVAF patients, only 3,024 received vitamin K antagonist (VKA). Potential barriers decreasing the probability of being treated with VKA were female sex, older age, antiplatelet treatment and history of bleeding. In addition, VKA-treatment was not in line with current ESC and AIAC guidelines, since the patients at high or low risk of stroke were under- or over-treated, resp. Among VKAtreated patients, 73 % of subjects were not at target with anticoagulation. OAT resulted to be effective in reducing stroke risk. However, stroke events were significantly influenced also by previous stroke or transient ischemic attack (hazard ratio, HR = 2.99, p < 0.001) and by previous bleeding events (HR = 1.60, p < 0.001).

Prevalence, costs and consequences of “manovra AIFA” for ICS-LABA treatment in patients with asthma or COPD: a real-practice analysis

Introduction The pharmaceutical respiratory market represents a growing expenditure for the National Healthcare System (NHS), mainly due to the increasing use of corticosteroid + long-acting β2 agonist (ICS-LABA) associations. Following a supplementary budget program (“manovra AIFA”, MA) in 2015, a reduction in drug costing was put in place which resulted in a de facto reduction in price and/or in a pay back provision (2015-2017). This study aimed to evaluate the impact of MA on ICS-LABA and on total direct respiratory costs for ICS-LABA-treated patients. Methods A retrospective study conducted in the Local Health Authority of Treviso identified users of ICS-LABA in 2014. Patients with asthma or COPD were separately analyzed, according to patient exemptions. The expenditure for ICS-LABA and its variation following the MA were assessed; total direct respiratory costs were also calculated. Results ICS-LABA users were 9,017 and 41.18% of them had an exemption for asthma or COPD. Considering dual-indication ICS-LABA medications, the total annual cost was €842,234; after the MA, this expenditure will probably be reduced by 8.2%. Costs were higher in COPD patients compared to patients with asthma (€2,268.97 vs. €535.77 per patient/year), due to more frequent hospitalizations (22.0% vs. 2.9%). For patients with asthma, pharmaceutical treatment costs were the most expensive (78.4% of total costs). Discussion and conclusions A reduction in costs for respiratory medications occurred following the MA, but real savings for the NHS are difficult to estimate, due to the variability in delivery volume and in the consequent pay back quantification.

Thromboprophylaxis in patients with atrial fibrillation: a real practice analysis

BackgroundAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major preventable cause of stroke and hospitalizations, with an estimate prevalence of 2.5%. Current guideli...