L’erogazione delle terapie per l’infertilità in distribuzione diretta. Analisi dell’esperienza presso l’UOC Assistenza Farmaceutica Territoriale e Vigilanza dell’AUSL di Bologna
Valentina Valastro, Daniela D’Alonzo, Daniela Angelini, Stefano Grande, Marco Manzoli
Background Note 74 of National Health Service (NHS) provides for the repayment of infertility treatments, through diagnosis and Therapeutic Plan (TP) of specialized structures. According to the available evidence, there aren’t clinically significant differences in efficacy and safety between human and recombinant gonadotropins, the latter being much more expensive for cycle of treatment. The drugs are dispensed as multiples of 7 days of therapy, based on the amount of medication needed to arrive to the first planned clinical checkup. Then the dosage to complete the cycle is dispensed. Often, after the check, the quantities prescribed in the TP aren’t fully utilized.
The outcome of the study was to evaluate whether fractionated and targeted delivery can reduce the waste of such drugs and address the best cost-based therapeutic choice.
Materials and Methods Based on the prescriptions in TP, the quantity of therapy actually assumed for each patient was recorded, then the possible waste of drugs and the respective economic values were calculated.
Results In 2016, patients treated were 430 with a total expenditure of € 423,107 and a saving of € 65,702 (13%) as the result of fractioning the dispensation. In the first six months of 2017, patients treated were 260 with a spending of € 251.422 and a saving of € 43.766 (17%). The trend of prescriptions decreased but the saving increased. The most prescribed drugs were Follitropin alfa (recombinant gonadotropin) and Menotropin (human gonadotropin).
Conclusions The results obtained by fractionating the dispensation and monitoring the prescriptions confirm the importance of closer collaboration with specialized centers. The choice of the type of FSH-gonadotropin in ovarian stimulation should be dictated by the individual needs of the patients undergoing treatment, considering the dosage required, the most accepted mode of administration and the rational use of the economic resources assigned to the NHS.
Key words: infertility treatment, human gonadotropin, recombinant gonadotropins, Note 74, drug dispensing