Suchergebnisse

Medication non-adherence is an important public health concern, affecting health outcomes and overall health care costs. Adherence is becoming a priority included in the political agenda of health care system. In 2012 was launched from EC the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA). The EIP-AHA A1 Action Group is focused on prescription and adherence. Part of the results of this thesis have been made available to A1 Action Group as preliminary data that might be useful for the further focused interventions. This thesis aims to provide more evidence on relation between poor adherence and adverse outcomes and to define reason of poor adherence, by using drug-utilization approaches using different sources of health-related automated databases. The scope of the study is also to evaluate economic impact of enhancing adherence by using real-life approach. The case study is population exposure to anti-osteoporotic drugs: with ageing populations, the burden of osteoporotic fractures on society will increase in the coming years and the prevention of osteoporotic fractures is therefore a major public health issue. The results showed sub optimal level of persistence and drug regimen is one of the strong predictors of non-adherence. Gender influences adherence to therapy and this is an issue that could be taken in strong consideration in tailor intervention to improve adherence. Another aspect is comorbidity this highlighted that an approach centered on comorbidity/multimorbidity, could be more pertinent, in particular when address health issues concerning older people. The ICER , expressed in terms of cost/fracture avoided equals € 821. This value indicates the cost that the NHS should support each fracture avoided This thesis demonstrated the potential of the use of existing data sources to evaluate appropriateness of drug use. Drugs cost money to buy, but if we use them in an appropriate way we can also save costs in other areas. In particular enhancing adherence to medication may lead to reductions in the number of patients requiring hospitalization. This research only explored cost effectiveness of improve adherence in drug use for osteoporosis, but clearly many different pattern of drugs for chronic conditions could be assessed in a similar way.

Riconosciuto il problema dell'accesso ai farmaci come un problema di giustizia globale, la dissertazione, da un lato, è incentrata sullo studio dei diritti umani e sul diritto alla salute da una prospettiva giusfilosofica e, dall'altro, è finalizzata ad analizzare la disciplina brevettuale internazionale, sia approfondendo gli interessi realmente in gioco, sia studiando la struttura economica del brevetto stesso. Si è cercato quindi di guardare a tali interessi da una nuova prospettiva, ipotizzando una gerarchia di valori che sia completa e coerente con gli obiettivi che la dottrina, la giurisprudenza, nonché il diritto internazionale formalmente enunciano. Il progetto di ricerca vuole, in definitiva, arrivare a proporre nuove soluzioni giuridiche al problema dell'accesso ai farmaci. La dissertazione svolge pertanto uno studio critico della proposta di Thomas Pogge, di natura politica e giuridica e sorretta da istanze filosofiche, volta alla soluzione del problema dell'accesso ai farmaci, i.e. l'Health Impact Fund (HIF). Proposta che pone radicalmente in discussione, anche concretamente, il dogma del monopolio concesso con la privativa quale ricompensa per i costi di R&D sostenuti dai titolari dei brevetti e che pone, invece, l'accento sull'effettivo impatto sulla salute globale di ogni singola invenzione. Analizzandone approfonditamente gli aspetti più rilevanti, si passano poi in rassegna, criticamente, le proposte, alternative o di riforma, del sistema di proprietà intellettuale, volte al miglioramento dell'accesso ai farmaci; a tal proposito, si propone quindi una riforma transitoria della disciplina brevettuale, c.d. Trading Time for Space (TTS), che prevede un allungamento temporale dell'esclusiva brevettuale (Time) in cambio della vendita da parte del titolare della privativa del farmaco ad un prezzo accessibile nei Paesi in via di sviluppo (Space). ; Considering the problem of access to drugs as a global justice problem, the dissertation, on the one hand, focuses on human rights and, namely, on the right to health from a legal and philosophical perspective and, on the other hand, aims at analyzing the international patent system, investigating the interests actually at stake and assessing the economic structure of patents. The dissertation looks at such interests from a new perspective, consistent with the objectives that scholars, case law and international law formally declare. The dissertation will, eventually, propose new solutions to the problem of access to medicines. The dissertation therefore offers a critical study of the proposal by Thomas Pogge, which has political, legal and philosophic grounds aiming at the solution of the access to drugs problem. The Health Impact Fund (HIF) gives a radical challenge, even in practice, to the dogma of the monopoly granted as a reward for R&D costs, incurred by patent holders, by giving instead emphasis on the effective impact on global health by each invention. By analyzing in detail their main aspects, the dissertation then critically describes other recent proposals for the reform of the intellectual property system, in order to improve access to drugs. In this regard, a transitional reform of the patent system, the so-called Trading Time for Space (TTS), is proposed, proposing an extension of the patent exclusivity (Time) in exchange for the sale by the holder of the patent at an affordable price in developing countries (Space).