Background Pain is associated with significant economic, social and health impact. The cost of uncontrolled pain is enormous, both to individuals and to society as it leads to a decline in quality of life and disability. Several publications and guidelines stress the efficacy and safety of opioid-based treatment for cancer and non-cancer pain management. Until recently Italian legislation was very restrictive concerning the use of opioids, making Italy one of the lowest users of medical opioids in Europe. In 2010 law no. 38 eased the prescription of opioids for cancer and non-cancer pain.
Purpose To evaluate the incidence and cost of using morphine (N02AA01), oxycodone (N02AA05) and fentanyl (N02AB03) in order to assess prescribing patterns in the Local Health Authority (LHA) between 01/01/2010 and 30/09/2012.
Materials and Methods Data were collected from ‘Farmanalisi.it’ database which records all prescriptions reimbursed by the Messina LHA. All consumption data were expressed in a standardised way and costs as direct costs to the LHA and recorded on a data sheet.
Results During the 2010–2011 period the consumption of morphine (os/IV) remained substantially stable (1,763 units in 2010 vs. 1,730 in 2011). By contrast, consumption of oxycodone and transdermal fentanyl rose (for oxycodone 3,742 units in 2010 vs. 3,888 in 2011; for transdermal fentanyl 13.680 units in 2010 vs. 13,881 in 2011). The same trend was recorded for the first nine months of 2012 with 1,600 units for morphine, 2,236 units for oxycodone and 7,499 for transdermal fentanyl. For the LHA, in the evaluated period, direct costs of transdermal fentanyl were higher (978,428.11€) than the value reported for oxycodone (180,042.89€) and morphine (46,279.96€).
Conclusions Data obtained confirm that, in the Messina LHA, many patients received transdermal fentanyl as a first option although it is recommended only when oral morphine is inadequate. This data could allow an evolution of strategies adopted to control pain and form the basis for communication among healthcare providers, such as General Practitioners, in order to improve appropriate prescribing policies.
No conflict of interest.
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