Quale efficacia degli strumenti di governance prescrittiva? Risultati dall’applicazione delle note AIFA

Abstract

Introduction:: Prescription appropriateness is crucial for healthcare, balancing scientific evidence, optimal benefit/risk ratios and cost-effectiveness in alignment with the National Health System (NHS) sustainability. In Italy, various governance tools, including Notes AIFA, regulate drug reimbursements. This research aims to evaluate the impact of the introduction of Notes AIFA in curbing consumption and expenditures and assessing their lasting effects. We evaluate the effect generated by the Notes in terms of prescriptive appropriateness by assessing their effect on reducing overprescribing phenomena for drugs covered by the Notes. Note 96, focused on the prevention and treatment of vitamin D deficiency in adults, is used as a case study to evaluate the short- and long-term effectiveness of these tools on prescribing behaviors.

Methods:: Using a quasi-experimental approach, administrative data on pharmaceutical consumption in Tuscany over 60 months (22 pre- and 38 post-Note) were analyzed. Interrupted Time Series (ITS) analysis at regional, and local health authorities (LHAs), and primary care group practices (AFTs) was performed.

Results and conclusions:: The ITS analysis showed an immediate reduction in consumption rates and spending post-Note 96. This real-world study highlights short-term effectiveness and suggests a positive long-term impact, despite recognizing a physiological increase in consumption at the regional level. The findings emphasize that ongoing continual monitoring of its effectiveness is imperative to promptly identify failures in implementation and mitigate the risk of consumption escalation, potentially reverting to pre-intervention levels.

FIGURA 1 -

Effetto dell’introduzione della Nota su (A) Tasso di confezioni erogate (B) Tasso di giornate di terapia (DDD), (C) Tasso di spesa.

FIGURA 2 -

Stima dell’effetto dell’introduzione della Nota 96 per i tre outcome di interesse nel mese immediatamente successivo (Regione Toscana). Note: Ciascun punto identifica un’AFT e l’intensità dell’effetto aumenta all’aumentare dell’intensità del colore. Le 3 Aree Vaste sono rappresentate nei tre colori differenti (rosa per AV Nord-Ovest, giallo per AV Centro e grigio per AV Sud-Est).