How effective are prescriptive governance tools? Results from the application of AIFA notes


  • Giaele Moretti Laboratorio Management e Sanità, Scuola Superiore Sant’Anna, Pisa - Italy
  • Benedetta Dal Canto Laboratorio Management e Sanità, Scuola Superiore Sant’Anna, Pisa - Italy and Scuola di Specializzazione in Farmacia Ospedaliera, Università di Pisa, Pisa - Italy
  • Francesco Attanasio Settore Politiche del farmaco e appropriatezza, Regione Toscana, Firenze - Italy
  • Alma Martelli Scuola di Specializzazione in Farmacia Ospedaliera, Università di Pisa, Pisa - Italy and Dipartimento di Farmacia, Università di Pisa, Pisa - Italy
  • Francesca Ferrè Centro di Ricerca e Alta Formazione in Health Administration, Dipartimento di Scienze Biomediche per la Salute, Università Statale di Milano, Milano - Italy



AIFA notes, Appropriateness, Phamaceutical governance, Real-world evidence


Introduction: Prescription appropriateness is crucial for healthcare, balancing scientific evidence, optimal benefit/risk ratios and cost-effectiveness in alignment with the National Health System (NHS) sustainability. In Italy, various governance tools, including Notes AIFA, regulate drug reimbursements. This research aims to evaluate the impact of the introduction of Notes AIFA in curbing consumption and expenditures and assessing their lasting effects. We evaluate the effect generated by the Notes in terms of prescriptive appropriateness by assessing their effect on reducing overprescribing phenomena for drugs covered by the Notes. Note 96, focused on the prevention and treatment of vitamin D deficiency in adults, is used as a case study to evaluate the short- and long-term effectiveness of these tools on prescribing behaviors.

Methods: Using a quasi-experimental approach, administrative data on pharmaceutical consumption in Tuscany over 60 months (22 pre- and 38 post-Note) were analyzed. Interrupted Time Series (ITS) analysis at regional, and local health authorities (LHAs), and primary care group practices (AFTs) was performed.

Results and conclusions: The ITS analysis showed an immediate reduction in consumption rates and spending post-Note 96. This real-world study highlights short-term effectiveness and suggests a positive long-term impact, despite recognizing a physiological increase in consumption at the regional level. The findings emphasize that ongoing continual monitoring of its effectiveness is imperative to promptly identify failures in implementation and mitigate the risk of consumption escalation, potentially reverting to pre-intervention levels.


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How to Cite

Moretti, G., Dal Canto, B., Attanasio, F., Martelli, A., & Ferrè, F. (2024). How effective are prescriptive governance tools? Results from the application of AIFA notes. Global and Regional Health Technology Assessment, 11(1), 131–137.



Original Research Articles


Received 2024-01-26
Accepted 2024-04-30
Published 2024-06-10


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