title: Changing patterns of prescription in vitamin D supplementation in adults: analysis of a regional dataset.
abstract: Scientific interest in vitamin D has greatly risen during the last 10 years. The analysis of the changes in vitamin D prescriptions and related costs in a regional prescription dataset has revealed a profound increase in the period 2006-2013. Further studies on cost-effectiveness of such increase in vitamin D supplementation are needed.
  
  
  BACKGROUND
  The aim of this study was to analyze the changes in population-based prescription patterns of vitamin D supplements in the general population in an Italian regional setting during an 8-year period (2006-2013).
  
  
  METHODS
  Data have been retrieved from the database of reimbursed prescriptions of the Region of Tuscany containing all of the medical reimbursements for the whole regional population (total of 3,619,872 and 3,692,828 inhabitants in 2006 and 2013, respectively). Data referring to adult population (age 20-90+ years) have been considered for this analysis (3,033,530 in 2006 and 3,066,741 in 2013). Two different flows (pharmaceutical distribution dataset and general data flow) were taken into account, using the ATC5 coding system for vitamin D supplements alone or in combination with calcium or alendronate. The number of boxes dispensed was retrieved, the number of patients receiving a specific treatment was calculated, and a cost analysis was performed.
  
  
  RESULTS
  An upsurge in the prescriptions of vitamin D compounds was disclosed, mainly sustained by a 75.3-fold increase in cholecalciferol, in all age groups and both sexes. This occurred in parallel to a 4.3-fold rise in prescriptions of oral alendronate in combination with cholecalciferol, a slight decrease in dispensed alendronate alone, and a modest increase in the prescription of the combination of calcium salts and cholecalciferol, and calcium alone. The total cost for reimbursement by the Regional Health System for vitamin D-related compounds rose from €3,242,100 euros in 2006 to €8,155,778 in 2013.
  
  
  CONCLUSIONS
  The huge increase in vitamin D prescriptions and related costs in the last decade, as revealed by the analysis of a regional pharmaceutical dataset, reflects the increased awareness of the possible consequences of a poor vitamin D status. Further studies on cost-effectiveness of such increase in vitamin D supplementation are needed.
authors.affiliation: Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Cianferotti
authors.affiliation: Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Parri
authors.affiliation: Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Gronchi
authors.affiliation: Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Rizzuti
authors.affiliation: Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Fossi
authors.affiliation: Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy.
authors.forename: D M
authors.initials: DM
authors.lastname: Black
authors.affiliation: Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy. marialuisa.brandi@unifi.it.
authors.forename: M L
authors.initials: ML
authors.lastname: Brandi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002762:Cholecalciferol / Q000627:therapeutic use; D016208:Databases, Factual; D019587:Dietary Supplements; D016527:Drug Costs / Q000706:statistics & numerical data / Q000639:trends; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*; D012189:Retrospective Studies; D014807:Vitamin D / Q000627:therapeutic use*; D014808:Vitamin D Deficiency / Q000188:drug therapy / Q000453:epidemiology; D055815:Young Adult
chemical_list: D050071:Bone Density Conservation Agents; D014807:Vitamin D; D002762:Cholecalciferol; D019386:Alendronate
keywords: Calcidiol; Calcium; Cholecalciferol; Monitoring; Osteomalacia; Osteoporosis