Abstract
In Italy, drug expenditure governance is achieved by setting caps based on the percentage increase in hospital spending compared to the previous year. This method is ineffective in identifying issues and opportunities as it does not consider an analysis of the number of treated cases and per capita consumption in local and regional settings. The IRCCS (Scientific hospitalization and treatment institute) Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori” in Meldola, has developed and adopted an effective management model designed to oversee pharmaceutical expenditure, guarantee prescription appropriateness and quality of care to patients. The budget setting follows a structured process which evaluates determining factors of the expenditure such as expected patients calculated according to the epidemiology and to national and regional indications of appropriateness, mean cost per patient calculated on the average period of demonstrated efficacy of the drug and use of drugs with the best cost-effectiveness ratio. Strict monitoring and integrated purchasing processes allow for immediate corrective actions on expenditures, as well as a continuous dialogue with the region in order to guarantee consistent funding of IRST activities. The model, presented in this article is efficient and implements concepts beyond the conventional “silos” approach and national and regional governance tools, in terms of patient centricity.
Highlights
Attention in pharmaceutical governance has focused on hospital channel expenses (c.d. direct purchases, i.e., drugs purchased by the health facilities of the NHS (National Health Sistem), including class-based drugs in direct distribution and on behalf of, considered as distribution, directly to patients for use at home)
The budget setting follows a structured process which evaluates determining factors of the expenditure such as expected patients calculated according to the epidemiology and to national and regional indications of appropriateness, mean cost per patient calculated on the average period of demonstrated efficacy of the drug and use of drugs with the best cost-effectiveness ratio
Public Health 2021, 18, 13413 In Italy, according to the logic of a silo budget, the national cap for pharmaceutical expenditure is defined as a percentage of total funding for health expenses (National healthcare fund—FSN), supported by a rigid monitoring mechanism to ensure healthcare fund—FSN), supported by a rigid monitoring mechanism to ensure compliance compliance and contain overspending [2]
Summary
Attention in pharmaceutical governance has focused on hospital channel expenses (c.d. direct purchases, i.e., drugs purchased by the health facilities of the NHS (National Health Sistem), including class-based drugs in direct distribution and on behalf of, considered as distribution, directly to patients for use at home). This type of expense has grown more than the gross cost for class A drugs (drugs paid for and distributed by the National Health System, not for hospital use only) distributed directly to patients by hospital pharmacies or through territorial pharmacies (direct purchasing), more than a quarter of which are oncology drugs (26% in 2019).
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