OBJECTIVES: Low molecular weight heparins (LMWH) account for about 2% of total pharmaceutical expenditure. According to the national data, about a third of the treated patients are given amounts of LMWH higher than the maximum quantities prescribed by the summary of product characteristic (SPC), subjecting patients to unnecessary side effects without any additional benefit and with a waste of public resources. In order to reconcile the quality and equity of care to the sustainability of the Regional Health System (RHS), indicators on the appropriate use of the LMWH have been defined and assigned to the Local Health Units (LHUs) of the Region.

METHODS: At the beginning of 2016, the prescriptive appropriateness indicators designed to measure the gap between clinical practice and therapeutic recommendations were assigned to the LHUs, in the under-use areas, where there is indication but there’s no prescription, and areas of over- use, where there’s a prescription but there is no indication. With respect to LMWH, an indicator has been assigned that measures the percentage of patients treated with LMWH with a duration of therapy greater than the maximum duration reported in the SPC. The choice of indicators was shared with the clinicians. To LHUs has been assigned the mission of disseminating the indicators through audit initiatives with the prescribers.

RESULTS: In the two-year period 2016-2017, regional expenditure by LMWH decreased by over € 4 million, compared to an almost stable trend in the years preceding the introduction of the indicators. The overall performance of the indicator improved by 2%, with peaks of over 4% in some LHUs. The LHUs that have improved the performance have reduced the cost for patient treated with LMWH.

CONCLUSIONS: Through the application of appropriateness indicator, leading to an improvement in the health outcomes, a financial objective has been achieved, contributing to the sustainability of the RHS.