Use and reimbursement of off‐label drugs in pediatric anesthesia: the Italian experience. Issue 6 (3rd May 2014)

• Record Type: Journal Article
• Authors: Salvo, Ida; Landoni, Giovanni; Mucchetti, Marta; Cabrini, Luca; Pani, Luca; Morton, Neil
• Is Part Of: Paediatric anaesthesia. Volume 24:Issue 6(2014)
• Page Start: 625
• Page End: 631
• Publication Date: 2014-05-03
• Subjects: Pediatric anesthesia -- Periodicals; 617.96798
• DOI: 10.1111/pan.12403
• Languages: English
• ISSNs: 1155-5645

Abstract

<abstract abstract-type="main" id="pan12403-abs-0001"> <title>Summary</title> <sec id="pan12403-sec-0001" sec-type="section"> <title>Background</title> <p>Most of the drugs used in anesthesia are off‐label in children even if they present solid clinical evidence in adults. This lack of authorization is caused by multiple factors including the difficulty in conducting research in this area (due to the ethical concerns and/or the low number of available participants, the high variability of the outcome measures) and the lack of economic interest of the pharmaceutical companies (due to the limited market).</p> </sec> <sec id="pan12403-sec-0002" sec-type="section"> <title>Objective</title> <p>Define a list of medicinal products commonly used off‐label in pediatrics anesthesia to be reimbursed by Italian National Health System.</p> </sec> <sec id="pan12403-sec-0003" sec-type="section"> <title>Methods and results</title> <p>We hereby describe the methodological framework used to allow reimbursed use of a list of medicinal products, widely used off‐label in pediatric patients, ensuring the best therapeutic results with the lowest possible risk for children. A task force of pediatric anesthesiologists from Italy petitioned the Italian Medicines Agency (AIFA) to allow a number of commonly utilized but off‐label drugs for pediatric anesthesia to be reimbursed for specific indications. For each drug, both the supporting literature and expert opinion were used, and the resulting list of drugs allowed to be used/reimbursed officially by AIFA was significantly expanded. This paper documents one approach to the problem of off‐label use of drugs for pediatric patients that can be a model for future efforts.</p> </sec> <sec id="pan12403-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Continuous efforts are needed from government institutions and sponsors on drug development and on drug approval process in pediatrics, as research on drug effectiveness and safety is mandatory in children as in adults. At the same time, clinicians must become more familiar with the drug‐approval process, participate to sponsored trials, and perform ztrials themselves.</p> </sec> </abstract>