Romanelli Luca, Lucente Filippo
Department of Physiology and Pharmacology V. Erspamer, University of Rome Sapienza, P.le A. Moro 5, 00185 Rome, Italy.
Explor Res Clin Soc Pharm. 2022 Apr 1;5:100133. doi: 10.1016/j.rcsop.2022.100133. eCollection 2022 Mar.
Studies have shown that waste medicines generate a significant cost for the national health system (NHS) in many countries. No data are available on costs and therapeutic classes of unused medicines in Italy.Objective: Conduct a quantitative and qualitative analysis of unused medicines returned for disposal to selected pharmacies in Rome, Italy, as well as to estimate the related costs for the NHS.
Medicines returned to 4 pharmacies were collected for 8 months. Therapeutic class, number of remaining dosage units, remaining validity, and reimbursement by the NHS were analysed. The cost of reimbursed medicines was estimated on the prices provided by the Italian regulatory agency (AIFA).
The study sample consisted of 3219 medicine packages containing remaining dosage units, of which 72.4% had expired while 27.6% had not. The average remaining validity of unexpired medicines was 13 months. Medicines reimbursed by the NHS accounted for 73% of the total. Cardiovascular drugs and anti-infectives were the main therapeutic classes (17.2% and 15.2% of total packages, respectively), followed by gastrointestinal drugs, central nervous system (CNS) drugs, non-steroidal anti-inflammatory drugs (NSAIDs), and corticosteroids. The average of remaining dosage units found in the examined packages was 68% of the initial number of units. In terms of cost, antibiotics were the most relevant therapeutic class, followed by cardiovascular drugs, analgesics, corticosteroids, and NSAIDs. The estimated cost for the Italian NHS was € 200,656,780 per year.
Waste medicines constitute a significant, but reducible cost for the NHS. The high prevalence of anti-infectives in the study sample appears to be a distinctive Italian characteristic and may be due to inappropriate prescribing. Policies aimed at reducing waste should improve prescriptive appropriateness and increase the variety of packaging size.
研究表明，在许多国家，废弃药品给国家卫生系统（NHS）带来了巨大成本。意大利尚无关于未使用药品成本及治疗类别的数据。
对意大利罗马选定药店退回处理的未使用药品进行定量和定性分析，并估算NHS的相关成本。
收集了8个月内退回4家药店的药品。分析了治疗类别、剩余剂量单位数量、剩余有效期以及NHS的报销情况。根据意大利监管机构（AIFA）提供的价格估算报销药品的成本。
研究样本包括3219个装有剩余剂量单位的药包，其中72.4%已过期，27.6%未过期。未过期药品的平均剩余有效期为13个月。NHS报销的药品占总数的73%。心血管药物和抗感染药物是主要治疗类别（分别占总包数的17.2%和15.2%），其次是胃肠道药物、中枢神经系统（CNS）药物、非甾体抗炎药（NSAIDs）和皮质类固醇。所检查药包中发现的剩余剂量单位平均为初始单位数量的68%。在成本方面，抗生素是最相关的治疗类别，其次是心血管药物、镇痛药、皮质类固醇和NSAIDs。意大利NHS每年的估计成本为200,656,780欧元。
废弃药品对NHS来说是一项巨大但可降低的成本。研究样本中抗感染药物的高比例似乎是意大利的一个独特特征，可能是由于处方不当所致。旨在减少浪费的政策应提高处方的适当性，并增加包装尺寸的种类。
