The Challenge of Sustainability of High-Cost Oncological Drugs: A Budgeting Model in an Italian Cancer Center

Carla Masini, Davide Gallegati, Nicola Gentili, Ilaria Massa, Raffaella Ciucci and Mattia Altini
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Carla Masini: Oncological Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” IRST s.r.l., via Piero Maroncelli 40, 47014 Meldola, Italy
Davide Gallegati: Budget and Planning Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” IRST s.r.l., via Piero Maroncelli 40, 47014 Meldola, Italy
Nicola Gentili: Health Management, Data Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” IRST s.r.l., via Piero Maroncelli 40, 47014 Meldola, Italy
Ilaria Massa: Outcome Research Group, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” IRST s.r.l., via Piero Maroncelli 40, 47014 Meldola, Italy
Raffaella Ciucci: Independent Researcher, 00100 Rome, Italy
Mattia Altini: Health Direction Unit, Azienda Unità Sanitaria Locale della Romagna, via De Gasperi 8, 48121 Ravenna, Italy

IJERPH, 2021, vol. 18, issue 24, 1-16

Abstract: In Italy, drug expenditure governance is achieved by setting caps based on the percentage increase in hospital spending compared to the previous year. This method is ineffective in identifying issues and opportunities as it does not consider an analysis of the number of treated cases and per capita consumption in local and regional settings. The IRCCS (Scientific hospitalization and treatment institute) Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori” in Meldola, has developed and adopted an effective management model designed to oversee pharmaceutical expenditure, guarantee prescription appropriateness and quality of care to patients. The budget setting follows a structured process which evaluates determining factors of the expenditure such as expected patients calculated according to the epidemiology and to national and regional indications of appropriateness, mean cost per patient calculated on the average period of demonstrated efficacy of the drug and use of drugs with the best cost-effectiveness ratio. Strict monitoring and integrated purchasing processes allow for immediate corrective actions on expenditures, as well as a continuous dialogue with the region in order to guarantee consistent funding of IRST activities. The model, presented in this article is efficient and implements concepts beyond the conventional “silos” approach and national and regional governance tools, in terms of patient centricity.

Keywords: oncology; budget; process; sustainability; economy; effectiveness; oncology pharmacy (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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