Department of Public Health, Laboratory for Mother and Child health, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
J Clin Pharm Ther. 2013 Oct;38(5):373-8. doi: 10.1111/jcpt.12068. Epub 2013 Apr 24.
Italian children receive a high number of antibiotic prescriptions, and the use of second-choice antibiotics is common. A few studies in other countries have demonstrated that the implementation of international guidelines for the most common paediatric diseases may reduce the associated costs. A cost analysis of the expenditure for antibiotic prescriptions in outpatient children in the Lombardy region (Italy) and for each of the region's local health units (LHUs) was performed using a pharmacoepidemiological approach. The safety and cost impact associated with a quali-quantitative improvement in antibiotic prescribing was estimated.
The data source was the Lombardy region's prescription database (year 2008) for outpatient children <14 years old. The average total expenditure for each package, and per capita, was calculated for each active substance considered and for each LHU. An estimate of the possible cost reduction was elaborated using, as a reference, the prescription profile of a group of paediatricians that has been involved in initiatives concerning care for years. The hospital admission rates for acute respiratory infections (ARI) and their major complications were evaluated at the regional level and in the group of children followed by the reference paediatricians.
The cost reduction estimate reveals a possible decrease in antibiotic expenditure of about 3·6 million euros (-19·5%) in the Lombardy region. Large variability was observed between different LHUs (-33·3 to +9·2% of difference). The hospital admission rate was not different when comparing the group of children followed by the reference paediatricians to the rest of the study population, but the hospital admission rate for ARI was lower in the reference group (χ(2) = 16·4, P < 0·001).
This is the first Italian study to evaluate the costs related to a specific prescription profile, which already exists in the real setting, hypothesizing its application in a large outpatient child population of the same geographical area. The results show that by improving prescribing appropriateness, it is possible to reduce the expenditure associated with antibiotic prescriptions to outpatient children in the Lombardy region by about one-fifth. The lower rate of hospital admissions for ARI suggests that the adopted profile is also beneficial to children's health.
意大利儿童接受了大量的抗生素处方，并且经常使用二线抗生素。其他国家的一些研究表明，实施针对最常见儿科疾病的国际指南可能会降低相关成本。采用药物流行病学方法对意大利伦巴第地区（意大利）门诊儿童的抗生素处方支出以及该地区每个地方卫生单位（LHU）进行了成本分析。评估了抗生素处方质量和数量改进相关的安全性和成本影响。
数据来源是伦巴第地区 2008 年门诊儿童（<14 岁）的处方数据库。为每个活性物质和每个 LHU 计算了每个包装的平均总支出和人均支出。使用多年来参与护理计划的一组儿科医生的处方概况作为参考，估算了可能的成本降低。在区域水平和参考儿科医生随访的儿童组中评估了急性呼吸道感染（ARI）的住院率及其主要并发症。
成本降低估计表明，伦巴第地区的抗生素支出可能减少约 360 万欧元（-19.5％）。不同 LHUs 之间存在很大的差异（差异的-33.3 至+9.2％）。当比较参考儿科医生随访的儿童组与研究人群的其余部分时，住院率没有差异，但参考组的 ARI 住院率较低（χ（2）= 16.4，P <0.001）。
这是第一项评估与特定处方模式相关的成本的意大利研究，该模式已经存在于实际环境中，并假设将其应用于同一地理区域的大量门诊儿童人群。结果表明，通过提高处方的适当性，可以将伦巴第地区门诊儿童的抗生素处方相关支出减少约五分之一。ARI 住院率较低表明所采用的方案也有益于儿童的健康。
