Scientific Direction, Italian National Research Centre on Aging (INRCA), Ancona, Italy.
Drugs Aging. 2009 Dec;26 Suppl 1:75-87. doi: 10.2165/11534680-000000000-00000.
The aging of the general population in industrialized countries has brought to public attention the increasing incidence of age-related clinical conditions, because the long-term impact of diseases on functional status and on costs are greater in older people than in any other age group. With the aging of the population, it is becoming increasingly important to quantify the burden of illness in the elderly; this will be vital not only in planning for the necessary health services that will be required in coming years, but also in order to measure the benefit to be expected from interventions to prevent disability in older people. The management of multiple and chronic disorders has become a more important issue for healthcare authorities because of increasing requests for medical assistance and healthcare interventions. Among these, pharmacological treatments and drug utilization in older people are pressing issues for healthcare managers and politicians; indeed, a relatively small proportion of the population accounts for a substantial part of public drug costs. Two key sources of pressure are well known: the growing number of elderly persons, who are the highest per-capita users of medicines, and the introduction of new, often more expensive, medicines. On the other hand, the development of strategies for controlling costs, while providing the elderly with equitable access to needed pharmaceuticals, should be based on an evaluation of the economic impact of pharmacological care in older people, taking into account the burden of illness, drug utilization data, drug technology assessment evidence and results. Furthermore, there are major factors affecting pharmacological care in older people: for example inappropriate prescribing, lack of adherence and compliance, and the burden of adverse drug events. The assessment of these factors should be considered a priority in pharmacoeconomic evaluations in the aging population, and the most relevant evidence will be reviewed in this paper with examples referring to particular settings or conditions and diseases, such as the presence of cardiovascular risk factors, diabetes and chronic pain.
工业化国家的人口老龄化引起了公众对与年龄相关的临床疾病发病率上升的关注，因为与任何其他年龄组相比，疾病对老年人的功能状态和成本的长期影响更大。随着人口老龄化，量化老年人的疾病负担变得越来越重要；这不仅对规划未来几年所需的必要卫生服务至关重要，而且对于衡量干预措施预防老年人残疾的预期效益也至关重要。由于对医疗援助和医疗干预的需求不断增加，多种慢性疾病的管理已成为医疗保健当局更重要的问题。在这些问题中，老年人的药物治疗和药物利用是医疗保健管理人员和政策制定者关注的紧迫问题；事实上，人口中的一小部分人占公共药物成本的很大一部分。有两个主要的压力源是众所周知的：老年人数量的增加，他们是人均用药量最高的人群，以及新的、往往更昂贵的药物的引入。另一方面，控制成本的策略的发展，同时为老年人提供公平获得所需药品的机会，应该基于对老年人药物治疗的经济影响进行评估，同时考虑到疾病负担、药物利用数据、药物技术评估证据和结果。此外，还有影响老年人药物治疗的主要因素：例如不适当的处方、缺乏依从性和顺应性以及不良药物事件的负担。在老龄化人口中的药物经济学评估中，应优先考虑这些因素的评估，本文将对这些因素进行审查，并举例说明特定的环境或条件以及疾病，如心血管风险因素、糖尿病和慢性疼痛的存在。
