title: Use and reimbursement of off-label drugs in pediatric anesthesia: the Italian experience.
abstract: BACKGROUND
  Most of the drugs used in anesthesia are off-label in children even if they present solid clinical evidence in adults. This lack of authorization is caused by multiple factors including the difficulty in conducting research in this area (due to the ethical concerns and/or the low number of available participants, the high variability of the outcome measures) and the lack of economic interest of the pharmaceutical companies (due to the limited market).
  
  
  OBJECTIVE
  Define a list of medicinal products commonly used off-label in pediatrics anesthesia to be reimbursed by Italian National Health System.
  
  
  RESULTS
  We hereby describe the methodological framework used to allow reimbursed use of a list of medicinal products, widely used off-label in pediatric patients, ensuring the best therapeutic results with the lowest possible risk for children. A task force of pediatric anesthesiologists from Italy petitioned the Italian Medicines Agency (AIFA) to allow a number of commonly utilized but off-label drugs for pediatric anesthesia to be reimbursed for specific indications. For each drug, both the supporting literature and expert opinion were used, and the resulting list of drugs allowed to be used/reimbursed officially by AIFA was significantly expanded. This paper documents one approach to the problem of off-label use of drugs for pediatric patients that can be a model for future efforts.
  
  
  CONCLUSIONS
  Continuous efforts are needed from government institutions and sponsors on drug development and on drug approval process in pediatrics, as research on drug effectiveness and safety is mandatory in children as in adults. At the same time, clinicians must become more familiar with the drug-approval process, participate to sponsored trials, and perform ztrials themselves.
authors.affiliation: Department of Anesthesia and Intensive Care, Children's Hospital V Buzzi, Milan, Italy.
authors.forename: Ida
authors.initials: I
authors.lastname: Salvo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Marta
authors.initials: M
authors.lastname: Mucchetti
authors.forename: Luca
authors.initials: L
authors.lastname: Cabrini
authors.forename: Luca
authors.initials: L
authors.lastname: Pani
mesh_terms: D000293:Adolescent; D000758:Anesthesia / Q000191:economics / Q000639:trends*; D000777:Anesthetics; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D007558:Italy; D008297:Male; D056687:Off-Label Use / Q000191:economics*
chemical_list: D000777:Anesthetics
keywords: Public Health Administration; anesthesiology; forensic medicine; off-label use; pediatrics; therapeutics