Consequences of Italy’s decision to restrict Vitamin D reimbursement for Osteoporosis prevention

Created April 2022

The Potential Impact of Inducing a Restriction in Reimbursement Criteria on Vitamin D Supplementation in Osteoporotic Patients with or without Fractures

Nutrients 2022, 14(9), 1877; https://doi.org/10.3390/nu14091877

by Luca Degli Esposti 1,Valentina Perrone 1,Stefania Sella 2,Gaetano Arcidiacono 2ORCID,Francesco Bertoldo 3,Andrea Giustina 4,Salvatore Minisola 5ORCID,Nicola Napoli 6,Giovanni Passeri 7ORCID,Maurizio Rossini 8ORCID andSandro Giannini 2,*,†ORCID on behalf of the LHU

Statistically significant consequences

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Increased strokes, use of antipsychotics etc.

VKA = vitamin K antagonist

In October 2019, the Italian Drug Agency (AIFA) restricted reimbursement criteria for vitamin D (VD) use outside the osteoporosis setting (Note 96). However, whether this restriction could also have involved patients at risk for or with osteoporotic fractures has not yet been investigated. We retrospectively analyzed databases from five Italian Local Health Units. Patients aged ≥50 years with either at least one prescription for osteoporosis treatment or with fragility fractures and evidence of osteoporosis from 2011 to 2020 were included. The proportion of subjects with an interruption in VD treatment before and after the introduction of the new reimbursement criteria and predictors of this interruption were analyzed. A total of 94,505 patients (aged 69.4 years) were included.

Following the introduction of Note 96, a 2-fold (OR 1.98, 95% CI: 1.92–2.04) increased risk of VD discontinuation was observed. These findings were independent of seasonal variation, osteoporosis treatment patterns, as well as other confounding variables. However, a higher rate of interruption was observed in patients without vertebral/femur fracture (37.8%) vs. those with fracture (32.9%). Rheumatoid arthritis, dyslipidemia and previous fracture were associated with a lower risk of VD interruption, while stroke increased the risk of VD interruption. Our results highlight that a possible misinterpretation of newly introduced criteria for reimbursement restrictions in VD outside of osteoporosis have resulted in an inadequate level of VD supplementation in patients with osteoporosis. This undertreatment could reduce the effect of osteoporosis therapies leading to increased risk of negative outcome.

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VitaminDWiki - Overview Osteoporosis and vitamin D contains

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VitaminDWiki - Osteoporosis category contains

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Various groups have tried to reduce costs of Vitamin D tests by restricting testing

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Tags: Osteoporosis