Analisi farmacoeconomica delle prescrizioni pediatriche extraospedaliere in un contesto italiano

Information is lacking regarding the actual cost of drugs used in children. Most drugs used in children are prescribed by general practitioners in an ambulatory setting. In order to evaluate National Health Service (NHS) and family expenditures on drugs used in pediatric general practice, a survey was carried out regarding the ambulatory visits of a group of pediatricians in Southern Italy. Visits were collected throughout a period of 13 weeks (February-April) with an index day methodology and all prescriptions made during the visits were used for the cost analysis. NHS and family costs were evaluated according to reimbursement modalities for drug prescriptions. Total expenditure induced by all prescriptions made during the study period was 148,555,500 Italian lira (ITL); 54% of this was sustained by the NHS, whereas the remaining was paid by families. When costs were corrected according to the actual prescription modalities used by the pediatricians in the survey, including the various reimbursement forms and telephone prescriptions, the result was that 49% of total expenditure was covered by NHS and 51% by families. An analysis of expenditures according to Anatomical Therapeutical Chemical classification system (ATC) showed that drugs for symptomatic therapies (e.g., cough and cold preparations, analgesics, antipyretics, etc.) and vitamins accounted for most of the families' expenditures, whereas antibacterial and antiasthmatic drugs did for the NHS. Of the ten most prescribed drugs, three were charged entirely to the family: acetaminophen (the most prescribed drug), morniflumate, and ambroxol. A large variability in average cost per treated child was found among the different pediatricians, regarding all prescriptions given, antibiotics, for otitis therapy and antibiotics given for otitis. The therapeutic indications that resulted in the major expenditures for families were the common trivial childhood symptoms, such as cough, fever, rhinitis, flu, and pharyngitis. Despite universal coverage for pharmaceutical care, more than half of drug therapy expenditures for children was covered by parents. Prescription attitudes of general practitioners remain the crucial factor for an equal distribution between patients (or parents) and NHS.