ABSTRACT
Title
Prescription of anti-osteoporosis drugs during 2004-2006 in an Italian Local Health Unit
Authors
M. Casula1, E. Tragni1, A. Filippi2, F. Decè3, L. Defendi3, L. Gandolfi3, L. Perego4, R. Piccinelli3, A.L. Catapano1
1Epidemiology and Preventive Pharmacology Centre (SEFAP), Department of Pharmacological Sciences, University of Milan, Italy
2Italian Society of General Medicine (SIMG) , Florence, Italy
3Pharmacoeconomics units, LHU of Bergamo, Italy
4Primary care department, LHU of Bergamo, Italy
1Epidemiology and Preventive Pharmacology Centre (SEFAP), Department of Pharmacological Sciences, University of Milan, Italy
2Italian Society of General Medicine (SIMG) , Florence, Italy
3Pharmacoeconomics units, LHU of Bergamo, Italy
4Primary care department, LHU of Bergamo, Italy
Abstract
Background. Osteoporosis is a common disease in the elderly, with an estimated 23% of women after the age of 40 and 14% of men over 60 sufferers in Italy. The resulting increased risk of fractures leads not only in increased morbidity and mortality, but also in the consumption of health resources.
Objective. To analyze the prescription pattern of anti-osteoporosis drugs (AODs) in the Local Health Unit of Bergamo (Northern Italy) during 2006–2008.
Design and setting. An observational, retrospective study was conducted. Data on prescriptions of AODs, reimbursed under “Nota 79” criteria, were retrieved from the Pharmaceutical Service of Bergamo, an administrative database that covers the total population in ambulatory care of the district of Bergamo (total population 1.063.305 in 2008). Key measurements were 1-year prevalence, total consumption measured in DDD, changes in therapy, and costs.
Results. Among more than one million of habitants in the province of Bergamo, subjects treated with the drugs listed were 6820 (prevalence of use by 1000 subjects 6.6) in 2006, 9324 (8.9) in 2007 and 11,015 (10.4) in 2008, with an increase of 63.1% from 2006 to 2007 and 42.1% from 2007 to 2008, and corresponding increased consumptions, from 3.62 to 6.13 DDD/1000 inhabitants/day. The annual costs of osteoporotic treatment to National Health System increased from €1,918,506 in 2006 to €2,933,638 in 2008. In the whole period, the percentage of women remained stable around 90%, and the average age was 72 years. Both the rate of incidence (users without prescriptions in the year preceding the first prescription) and of abandonment of therapy (users without prescriptions in the year following the first prescription) were higher for men (women, 45.2% and 34.3% of new user vs men, 54.8% and 47.7% of new users, respectively in 2007 and 2008; drop-out women, 22.0% and 24.5% vs drop-out men, 35.8% and 41.4%, respectively in 2006 and 2007). The percentage of different AODs has varied over 3 years of observation (p for trend <0.001). The use of alendronate with colecalciferol, ibandronate, strontium ranelate, and teriparatide increased from 2006 to 2008 while the use of other drugs decreased. A sub-analysis stratified by sex showed significant (p <0.001) but slight differences in the distribution of AODs for men and women in three years, except for alendronic acid, which proportion of male users was about 10 percentage points higher than female users. Another sub-analysis stratified by age group has estimated that about 50% of subjects treated with raloxifene were below the age of 65 in all 3 years of observation; patients treated with teriparatide were mainly between 65 and 74 years (56%) in 2006, while in 2006 and 2007 almost half were aged between 75 and 84 years. The prescription in the over 50s has seen a reduction in frequency for all AODs with the exception of the association alendronate + Vitamin D and strontium ranelate. As a result the marketing of generic drugs (70 mg alendronic acid since 2006), the rate of prescription of these products has increased from 0.5% in 2006 to 12.8% in 2007, and to 17.0% in 2008. Weekly administration was prevalent, although over time the proportion of patients treated with drugs in a weekly regimen decreased (-11.6%) in favour of those given daily (+6.6%) or monthly (+4.9%). The proportions of therapeutic changes were low in the whole period, about 4-5% for drug change and about 3% for frequency change.
Conclusion. There was an increasing prevalence of AODs use over this 3-years time period. The increased pharmacological costs, under the assumption of a proper drug use, could result from a preventive cost-effective approach.
Objective. To analyze the prescription pattern of anti-osteoporosis drugs (AODs) in the Local Health Unit of Bergamo (Northern Italy) during 2006–2008.
Design and setting. An observational, retrospective study was conducted. Data on prescriptions of AODs, reimbursed under “Nota 79” criteria, were retrieved from the Pharmaceutical Service of Bergamo, an administrative database that covers the total population in ambulatory care of the district of Bergamo (total population 1.063.305 in 2008). Key measurements were 1-year prevalence, total consumption measured in DDD, changes in therapy, and costs.
Results. Among more than one million of habitants in the province of Bergamo, subjects treated with the drugs listed were 6820 (prevalence of use by 1000 subjects 6.6) in 2006, 9324 (8.9) in 2007 and 11,015 (10.4) in 2008, with an increase of 63.1% from 2006 to 2007 and 42.1% from 2007 to 2008, and corresponding increased consumptions, from 3.62 to 6.13 DDD/1000 inhabitants/day. The annual costs of osteoporotic treatment to National Health System increased from €1,918,506 in 2006 to €2,933,638 in 2008. In the whole period, the percentage of women remained stable around 90%, and the average age was 72 years. Both the rate of incidence (users without prescriptions in the year preceding the first prescription) and of abandonment of therapy (users without prescriptions in the year following the first prescription) were higher for men (women, 45.2% and 34.3% of new user vs men, 54.8% and 47.7% of new users, respectively in 2007 and 2008; drop-out women, 22.0% and 24.5% vs drop-out men, 35.8% and 41.4%, respectively in 2006 and 2007). The percentage of different AODs has varied over 3 years of observation (p for trend <0.001). The use of alendronate with colecalciferol, ibandronate, strontium ranelate, and teriparatide increased from 2006 to 2008 while the use of other drugs decreased. A sub-analysis stratified by sex showed significant (p <0.001) but slight differences in the distribution of AODs for men and women in three years, except for alendronic acid, which proportion of male users was about 10 percentage points higher than female users. Another sub-analysis stratified by age group has estimated that about 50% of subjects treated with raloxifene were below the age of 65 in all 3 years of observation; patients treated with teriparatide were mainly between 65 and 74 years (56%) in 2006, while in 2006 and 2007 almost half were aged between 75 and 84 years. The prescription in the over 50s has seen a reduction in frequency for all AODs with the exception of the association alendronate + Vitamin D and strontium ranelate. As a result the marketing of generic drugs (70 mg alendronic acid since 2006), the rate of prescription of these products has increased from 0.5% in 2006 to 12.8% in 2007, and to 17.0% in 2008. Weekly administration was prevalent, although over time the proportion of patients treated with drugs in a weekly regimen decreased (-11.6%) in favour of those given daily (+6.6%) or monthly (+4.9%). The proportions of therapeutic changes were low in the whole period, about 4-5% for drug change and about 3% for frequency change.
Conclusion. There was an increasing prevalence of AODs use over this 3-years time period. The increased pharmacological costs, under the assumption of a proper drug use, could result from a preventive cost-effective approach.