Background Imatinib (Gleevec) is a protein kinase inhibitor initially registered in Italy as an orphan drug for the treatment of chronic myeloid leukaemia (CML) and gastro-intestinal stromal tumours (GIST): its use in clinical practice began in 2004 with a cost to the public per pack of 3,313.47 € (2,007.67 € ex -factory). The dosage varies from 400–800 mg/day and must be continued chronically until disease progression (DP) or until side effects appear.
Purpose To examine the level of spending on imatinib in the National Cancer Institute of Milan (INT) compared with consumption in Italy.
Materials and methods We interrogated the national reports on the use of drugs in Italy (OsMed) published by the AIFA requesting a report on consumption (extracted from the flow of File F for active drug) by number of treated patients and by department (SC Haematology and SC Sarcomas), in order to proceed to the comparison.
Results Analysis of the data revealed that in the course of 5 years (2008–12) the expenditure at the national level went from 144,700,000 € to 122,478,260 € (period Jan–Sept 2012), peaking at 173,300,000 in 2011 €. In INT the figures were 2,419,605 € in 2008 to 2,881,185 € in 2012, peaking at nearly 3 million euro in 2011. The decrease since 2011 is considered to be linked to two factors:
some patients showed resistance to the treatment, so they switched to use a second line treatment with sunitinib;
some local health authorities have intervened in the supply of the drug to their patients.
Conclusions In the period under consideration, INT expenditure was about 6% of the entire national expenditure, about 11.6% of the expenditure of the BPE. According to the latest epidemiological data, a slight increase is expected in new diagnoses with a consequent increase in spending both nationally and in individual structures. Will the NHS manage to ensure the continuity of care for life, with an average cost for each treatment of about 80 €/day? Is it necessary to wait for 2016 for the generic drug or should we turn to the Indian market, where the average cost is about 9 €/day?
No conflict of interest.
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