ASSET (AgeSex Standardised Estimates of Treatment) A Research Model to Improve the Governance of Prescribing Funds in Italy 英文参考文献.docVIP

ASSET(Age/SexStandardisedEstimatesofTreatment):A ResearchModeltoImprovetheGovernanceof PrescribingFundsinItaly GiampieroFavato1,3*,PaoloMariani2,RogerW.Mills1,AlessandroCapone3,MatteoPelagatti2,VascoPieri3,AlbericoMarcobelli4,MariaG. Trotta5,AlbertoZucchi6,AlbericoL.Catapano3,7 1SchoolofProjects,ProcessesandSystems,HenleyManagementCollege,Henley-on-Thames,UnitedKindgom,2DepartmentofStatisticalScience, BicoccaUniversity,Milan,Italy,3ServiziodiEpidemiologiaeFarmaciaPreventiva(SEFAP),Milan,Italy,4RegionalHealthAuthority(ASSR)Marche, Ancona, Italy, 5Regional Health Authority (ASSR) Basilicata, Potenza, Italy, 6Local Health Authority (ASL) Milano 3, Monza, Italy, 7Department of PharmacologicalSciences,UniversityofMilan,Milan,Italy Background.Theprimaryobjectiveofthisstudywastomakethefirststepinthemodellingofpharmaceuticaldemandin Italy, by deriving a weighted capitation model to account for demographic differences among general practices. The experimental model was called ASSET (Age/Sex Standardised Estimates of Treatment). Methods and Major Findings. Individual prescription costs and demographic data referred to 3,175,691 Italian subjects and were collected directly from threeRegionalHealthAuthoritiesoverthe12-monthperiodbetweenOctober2004andSeptember2005.Themeanannual prescriptioncostperindividualwassimilarformales(196.13euro)andfemales(195.12euro).After65yearsofage,themean prescribing costsformaleswere significantlyhigherthan females. Onaverage, costsfora75-year-old subjectwouldbe 12 timesthecostsfora25–34year-oldsubjectifmale,8timesiffemale.Subjectsover65yearsofage(22%oftotalpopulation) accounted for 56% of total prescribing costs. The weightings explained approximately 90% of the evolution of total prescribingcosts,inspiteofthepricingandreimbursementturbulencesaffectingItalyinthe2000–2005period.TheASSET weightings were able to explain only about 25% of the variation in prescribing costs among individuals. Conclusions. If mainly idiosyncratic prescribing by ge