title: Impact of regional copayment policy on selective serotonin reuptake inhibitor (SSRI) consumption and expenditure in Italy.
abstract: OBJECTIVE
  The continuous growth of antidepressant consumption and expenditure, especially for selective serotonin reuptake inhibitors (SSRIs), has led to the adoption of several policy measures directed toward cost control in Western countries. In Italy, copayment policies have been heterogeneously introduced at a regional level as part of a strategy designed to reduce drug consumption. The aim of our study was to evaluate whether regional copayment policies have affected trends in the consumption of and expenditure for SSRIs from 2001 to 2007.
  
  
  METHODS
  The consumption of SSRIs was measured in terms of defined daily doses per 1,000 inhabitants (DDD/1000) per day from May 2001 to December 2007. Time trends in consumption and expenditure before and after the introduction of copayment policies were examined using segmented regression analysis of interrupted time-series, adjusting for seasonal components. The study was conducted for 17 regions, nine of which had implemented a copayment policy.
  
  
  RESULTS
  The overall consumption of SSRIs in Italy increased during the study period, from a monthly consumption of 12.85 DDD/1000 per day in May 2001 to 23.40 DDD/1000 per day in December 2007. The average monthly increase in SSRI use was 0.82 % in regions with a copayment policy versus 0.77 % in regions without a copayment policy (P = 0.329). According to the multivariable analysis, copayment was associated with a 1 % reduction in the monthly growth rate of SSRI consumption (P  = 0.01). The impact of copayment on expenditure was statistically significant (P  < 0.005) on both the level and the trend, even though the estimate of the effect was negligible.
  
  
  CONCLUSIONS
  The implementation of copayment policies in Italy affected both the use and expenditure of SSRIs between 2001 and 2007 to only to a minor extent.
authors.affiliation: Department of Public Health, Catholic University of the Sacred Hearth, Rome, Italy. gdamiani@rm.unicatt.it
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Damiani
authors.forename: Bruno
authors.initials: B
authors.lastname: Federico
authors.forename: Giulia
authors.initials: G
authors.lastname: Silvestrini
authors.forename: Caterina Bianca Neve Aurora
authors.initials: CB
authors.lastname: Bianchi
authors.forename: Angela
authors.initials: A
authors.lastname: Anselmi
authors.forename: Lanfranco
authors.initials: L
authors.lastname: Iodice
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ronconi
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Navarra
authors.forename: Roberto
authors.initials: R
authors.lastname: Da Cas
authors.forename: Roberto
authors.initials: R
authors.lastname: Raschetti
authors.forename: Walter
authors.initials: W
authors.lastname: Ricciardi
mesh_terms: D003363:Cost Control / Q000379:methods; D003669:Deductibles and Coinsurance / Q000191:economics*; D016527:Drug Costs / Q000639:trends; D004363:Drug Utilization / Q000191:economics*; D005102:Health Expenditures / Q000639:trends*; D007558:Italy; D011050:Policy Making; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics* / Q000600:supply & distribution*
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors