Chronic treatment of COPD: state of the art and real-world analysis of healthcare costs based on medication adherence data.

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD), represents a serious and growing health problem worldwide. Healthcare should be conceived and structured in a proactive logic mode predicting to promote prevention and supporting the patient in the path of care. This desirable approach could reduce the impact of chronicity on patient' quality of life and health care costs. In this context, the theme of therapeutic adherence represents one of the priorities on which to intervene. OBJECTIVE: To show a real life picture of the health expenditure and economics consequences due to non-adherent COPD therapy. MATERIALS AND METHODS: Patients with a COPD diagnosis were selected from the Regional Health Information System Edotto; consumption data was also obtained from the same patients and was based on data relating to prescriptions dispensed by affiliated pharmacies belonging to the Local Health Agency of the province of Barletta-Andria-Trani (LHA BT) in a time period including 2017 and 2018. The assisted patients not adhering to COPD treatment (medication possession ratio between 20% and 80%) in 2017 were included in the analysis. The system Edotto was used to verify how many of them had become adherent in 2018. For both groups of patients, the average cost per patient was assessed, both in terms of pharmaceutical expenditure and hospitalizations due to COPD. RESULTS: Of the 66 patients not adhering to the treatment in 2017, 66.67% (44 patients) became adherent to therapy and 33.33% (22 patients) remained non-adherent to treatment during 2018. The total cost (pharmaceutical expenditure ATC-R03 and the cost derived from hospitalizations due to COPD) for non-adherent patient during 2018 was 73% increase compared to the cost of the patient adhering to treatment (p=.000317), thus resulting a saving of € 992.56 per adherent patient. CONCLUSIONS: Adherence to COPD therapy can improve patient health and reduce healthcare costs.

Analysis of the Introduction in Clinical Practice of New Oral Anticoagulants in Local Health Agency BT: Translation of the Clinical Trial Data to a Local Health Care Area.

The commercial release of the New Oral Anticoagulants (NOACs) has been the most significant change in anticoagulant therapy in recent years. The work aimed to evaluate the economic and health impact for the Local Health Agency Barletta-Andria-Trani (BT). Through the Regional Information System data about naïve patients on NOAC treatment and patients on anti-vitamin-k (VKA), treatments were extrapolated. We assessed therapeutic continuity, pharmaceutical expenditure, hospitalizations, and deaths in 2017 and 2018. Therapeutic continuity was similar in the two groups. The number and the average cost of hospitalizations for a patient treated with VKAs were almost constant, while those of patients treated with NOACs decreased. The treatment of adult-aged naïve patients with NOACs, compared to VKAs therapy, involves an increase in expenditure of about 100€ for a patient, but the reduced hospitalizations could generate, in the long term, saving for the Health System. Clinical data, according to the Real-World Data, confirmed the safety and effectiveness of these drugs. However, attention to the special population is necessary to improve the safety and effectiveness of NOACs. Innovative formulations for pediatric patients are being developed. The challenge for Health Systems is the appropriate use of available resources through health interventions with transversal competences.