title: Public expenditure for plasma-derived and recombinant medicinal products in Italy.
abstract: BACKGROUND
  In Italy, the supply of plasma-derived medicinal products funded by the National Health Service can be through public healthcare facilities, accredited pharmacies or toll fractionation agreements between Regions and the manufacturer. Pharmaceutical public expenditure includes the supply related to the first two channels and costs can significantly vary because of channel-specific price reductions. This paper describes 2011 public expenditure for plasma-derived medicinal products purchased on the market, as well as the cost analysis per active substance.
  
  
  METHODS
  Analysis of the usage of plasma-derived medicinal products and of the related expenditure in public facilities has been carried out using medicinal product traceability data. The analysis related to the accredited pharmacies channel has been carried out using quantities for every medicinal package recorded by Pharmacy Associations and applying reference prices in force on March 1(st), 2012 as well as discounts for the accredited pharmaceutical expenditure imposed by law.
  
  
  RESULTS
  At national and regional level, total and total per capita expenditures on plasma-derived medicinal products by market channel and funded by the National Health Service are shown. Analysis was conducted considering the active substances in three groups: substances included in toll fractionation agreements, recombinant coagulation factors, and other substances not included in toll fractionation agreements. In 2011, the national expenditure estimate for plasma-derived and recombinant medicinal product acquisition on the market was about € 535 million.
  
  
  CONCLUSIONS
  The purchased volumes and mean purchased prices per unit of each substance have a significant influence on the observed regional variability of the pharmaceutical public expenditure. A strategy of regional comparison aimed at both sharing a national range of reference for purchase prices and evaluating modalities for centralised purchasing is desirable.
authors: Italian National Blood Centre, National Institute of Health, Rome, Italy IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Milan, Italy.
authors: Monica
authors: M
authors: Lanzoni
authors: Italian National Blood Centre, National Institute of Health, Rome, Italy.
authors: Fabio
authors: F
authors: Candura
authors: Italian National Blood Centre, National Institute of Health, Rome, Italy.
authors: Gabriele
authors: G
authors: Calizzani
authors: Information Systems, Ministry of Health, Rome, Italy.
authors: Claudia
authors: C
authors: Biffoli
authors: Italian National Blood Centre, National Institute of Health, Rome, Italy.
authors: Giuliano
authors: G
authors: Grazzini
mesh_terms: D000991:Antithrombins / Q000191:economics / Q000600:supply & distribution; D001779:Blood Coagulation Factors / Q000191:economics / Q000600:supply & distribution; D005164:Factor IX / Q000191:economics / Q000600:supply & distribution; D005169:Factor VIII / Q000191:economics / Q000600:supply & distribution; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000191:economics*; D007558:Italy; D008297:Male; D010949:Plasma; D011994:Recombinant Proteins / Q000191:economics / Q000600:supply & distribution
chemical_list: D000991:Antithrombins; D001779:Blood Coagulation Factors; D016756:Immunoglobulins, Intravenous; D011994:Recombinant Proteins; C025667:prothrombin complex concentrates; D005169:Factor VIII; D005164:Factor IX