Adherence in the limitation of expenditure of Antiretrovirals at the Hospital "Maggiore della Carità" of Novara

Since 2000, the average health expenditure per capita has increased by more than 50% in Italy, with a prevalent population over fifty years old and therefore with a high "consumption" of welfare services. An important item of these costs is pharmaceuticals: monoclonal antibodies, biological immunosuppressants, antineoplastic chemotherapies and antiretrovirals are the most expensive drugs. Expenditure for the management of HIV/AIDS has remained almost constant in recent years because despite an increase in drugs, which have induced the "chronicization" of the disease, visits and hospitalizations of patients have been reduced. In view of a bearable economic development, especially in future perspectives, it is however necessary a system of clinical governance that considers accessibility, sustainability and appropriateness of antiretroviral treatments: thus the poor adherence to these therapies causes the reduction of their effectiveness and the consensual increase of care and community costs.