Antifracture drugs consumption in Tuscany Region before the Target Project: a valuable model for the analysis of administrative database.

As the Target Project of Tuscany Region is aimed to identify significant changes occurring during the time of the project compared to the previous years, we have analyzed antifracture drugs consumption in the years immediately preceding the start-up of the program.We have analyzed the regional administrative database to search for antifracture drugs delivered by the regional healthcare system to people living in Tuscany in the year 2009. Both drugs directly distributed by hospitals or local health authorities (direct distribution dataset, FED), and those delivered through pharmacies (pharmaceutical distribution dataset, SPF) were included in the analysis. Private expenditures were indirectly computed because total pharmaceutical expenditures were also known. A specific subgroup analysis has been carried out on elderly patients with femoral fractures (years 2006-2010), which represent the population of Target Project, in order to assess the evolution of all antifracture drug prescriptions before the start up of the project.A total of 690,768 boxes of antifracture drugs (20 million defined daily doses, DDD) have been delivered in year 2009 for total expenditures of 23 million Euros. Public expenditures accounted for 71\% of the total (16 million; 6\% of regional pharmaceutical expenditures). Alendronate and risedronate were the most used drugs. The number of antifracture medications prescribed within the first 90 days to elderly people with hip fractures increased in the period before the start-up of the Target project but they remained under 14\%.There is the need for an appropriate management of antifracture therapies, as they represent a valuable proportion of pharmaceutical expenditures. This need is pointed out also by the remarkable amount of direct private expenditures and by the few number of hip fractured people starting a treatment.