Effetto dei fabbisogni terapeutici sesso ed età correlati sui costi di prescrizione nella medicina generale

Summary

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–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 of prescribing 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 data.