Italians and drugs: almost two pills per head, boom of anti-obesity and psychotropic drugs among children

In 2024, 1,895 doses of medication were consumed per 1,000 inhabitants per day in Italy, i.e. each citizen, including children, took approximately 1.9 doses of medication. 70.8% is provided by the National Health Service and the remaining 29.2% is purchased privately. With regard to public and private territorial assistance, almost 2 billion packages were dispensed, slightly less than in 2023. This is what emerges from the OsMed 2024 Report, produced by the Italian Medicines Agency (Aifa), on the use of medicines in Italy. The most recent signs of drug consumption in Italy include the growth of anti-obesity drugs (+13%) and psychotropic drugs among children, which have doubled in a decade. Last year, around 4.6 million children and adolescents between the ages of zero and 17 in Italy received at least one pharmaceutical prescription: practically half of the paediatric population. But if we take into account all the packages sold to children - more than 20 million - that's more than 2 drugs per head

 Of the drugs reimbursed by the SSN, drugs for the cardiovascular system are in first place in terms of consumption (523 daily doses per 1,000 inhabitants) and in second place in terms of expenditure (3.7 billion euro) behind anti-cancer and immunomodulators (approximately 8.2 billion euro). In second place in terms of consumption are drugs for the gastrointestinal and metabolic system (296 daily doses per 1000 inhabitants), which are the third category in terms of expenditure (3 billion 495 million euro), with a per capita SSN expenditure of 59.3 euro, up 5.1% on the previous year. Blood and haemopoietic organ drugs rank third in terms of consumption (145.2 daily doses per 1,000 inhabitants) and fifth in terms of expenditure (€ 2.647 billion). Central nervous system drugs rank fourth in terms of consumption (99.8 daily doses per 1,000 inhabitants) and sixth in terms of expenditure (EUR 2.148 billion). Overall, in 2024, 68% of patients received at least one prescription for medication, women (72.1%) more than men (63.6%). The gender differences are most marked in the 20-59 age group, where women have more prescriptions for antibiotics (used to treat urinary tract infections), anti-anaemics and central nervous system drugs, particularly antidepressants.

In Italy, the use of the new anti-obesity drugs, Glp-1 analogues, already used in the fight against diabetes, is growing. In 2024, antidiabetic drugs recorded a total public expenditure 'of 1 billion 642 million euro, an increase of 13.2% compared to 2023. In fact, both consumption (+4.3%) and the average cost per dose (+8.3%) have increased, with a shift in consumption towards categories of drugs more recently introduced in therapy, such as Glp-1 analogues, glyflozines and their combinations - warns the Medicines Agency - In particular, glp-1 analogues, to which semaglutide belongs, despite a reduction in average cost of 1.8 per cent, show an increase in expenditure of 11.5 per cent and in consumption of 13.3 per cent, with semaglutide alone growing by 58.4 per cent and 59.8 per cent respectively'. In 2024, they are the category, alone or in combination with insulins, with the highest annual cost per user (€ 722.5 for Glp-1 analogues alone and € 736.1 in combination with insulins). Glyptins alone recorded an increase in expenditure (+35.5%) attributable - the report states - exclusively to the increase in the average cost per day of therapy (+40.3%), considering the 3.7% drop in consumption. Finally, for glyflozines alone there was an increase in expenditure of 39.6% and in consumption of 45.1% (but a reduction in the average cost per day of therapy of 4.1%)'. "Metformin, when used alone, is still the most widely used drug in the treatment of diabetes (23.4 daily doses per 1,000 inhabitants), accounting for 31.5% of the total, while the new GIP and GLP-1 receptor agonist drugs, represented by tirzepatide, are the category with the highest average cost per day of therapy with a value of €130.57," the report recalls.

In less than 10 years, the prevalence of psychotropic drug use among Italian children and adolescents has more than doubled: 0.26% of minors took them in 2016, rising to 0.57% in 2024, or 1 in every 175 minors. At the same rate, the consumption of psychopharmaceuticals rose from 20.6 packs per 1,000 children to 59.3 packs. The most prescribed mental health drugs in children are mainly antipsychotics, antidepressants and Adhd drugs. Prescriptions increase as age increases, with the 12-17 year old group recording the highest level of consumption (129.1 packages per 1,000 and a prescription level of 1.17% of children). The trend is in line with the results of other international epidemiological studies, which show a general upward trend in prescription rates for these drugs in all countries of the world, especially following the pandemic. "In Italy, despite the increase observed in recent years, in part linked to the consequences of the pandemic emergency on the mental health of children and adolescents, the use of psychotropic drugs remains significantly lower than in other countries," Aifa points out. In fact, "in 2024, the prescription of these drugs in the Italian paediatric population stands at 0.57%, a figure that has doubled compared to 2020 (0.30%), but is still lower than in other European countries (e.g. France with 1.61%) and non-European countries (USA 24.7%-26.3%)". With regard to other drugs prescribed to minors, the Report shows that in 2024, slightly more than half of the paediatric population (4.6 million children and adolescents) received at least one prescription with a slightly higher prevalence in males than in females (51.9% versus 49.9%). Anti-infectives for systemic use are confirmed as the therapeutic category with the highest consumption in paediatric age, followed by respiratory drugs and systemic hormonal preparations, excluding sex drugs and insulins.