Il costo della distribuzione diretta dei farmaci in dieci Aziende Sanitarie piemontesi

Regional governments have introduced, among other policies, peculiar way of distributing drugs: direct drugs distribution by health authorities (DD) and distribution by community pharmacies on behalf of health authorities (DPC). Distribution strategies by health authorities are partially influenced by economic consideration and costs are one of the component of the economic impact of different possible course of actions. The purpose of this paper is to estimate the costs of the 2012 DD in ten health care organisations in the Piedmont Region, which represent 48% of the beds in the region. The study aims also to simulate the difference between the costs of the DD and those that healthcare organizations would have incurred if the same drugs were distributed in DPC, estimated on the grounds of the various agreements over time between the Piedmont Region and the distribution, or in conventional regime. The study covers an important gap in the (information) literature, since the current studies on the costs of DD are limited and mostly related to individual case-studies. The estimate of the organizational costs of direct distribution could rely on the systematic collection of analytical data in the relevant organisations and other information not routinely collected (e.g. time devoted to DD by hospital pharmacists). The authors have introduced the conservative hypothesis that health care organisations do not sustain any organisational cost neither for DPC nor for ordinary distribution, apart from DPC storing costs by the leading health care organisation. The drug acquisition cost in DPC was assumed the same as that in DD, while the cost of drugs in conventional regimen was estimated on the basis of list price net of discounts and co-payment. The organisational cost per directly distributed pack shows important variations across organisations: its weighted average value is 2.3 € (with important variations across health care organisations - the organisation cost per pack ranging through € 0,7 and € 11.1), which is lower than the fee paid to pharmacies through the DPC. If 2012 fees for DPC are used, DPC would imply a 10% increase of costs (6.4 million €). If 2013 and 2014 fees are used, potential savings thanks to DD (compared to DPC) would drop to 4.1 and 3.7 million € respectively. If drugs were ordinarily distributed they would cost 26 million € more than in the case of DD: pharmacies are not paid if drugs are directly distributed and actual price in the case of DD is 48.5% of the list price on average.