Shortage of Albendazole and Its Consequences for Patients with Cystic Echinococcosis Treated at a Referral Center in Italy

Tommaso Manciulli Department of Experimental Medicine, University of Pavia, Pavia, Italy;
Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;

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Ambra Vola Unit of Infectious and Tropical Diseases, Istituto di Ricovero e Cura a Carattere Scientifico San Matteo Hospital Foundation, Pavia, Italy;

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Mara Mariconti Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;

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Raffaella Lissandrin Unit of Infectious and Tropical Diseases, Istituto di Ricovero e Cura a Carattere Scientifico San Matteo Hospital Foundation, Pavia, Italy;

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Marcello Maestri Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;
Department of Surgery, IRCCS San Matteo Hospital Foundation, Pavia, Italy;

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Christine M. Budke Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, Texas;

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Francesca Tamarozzi Center for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Verona, Italy

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Enrico Brunetti Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;
Unit of Infectious and Tropical Diseases, Istituto di Ricovero e Cura a Carattere Scientifico San Matteo Hospital Foundation, Pavia, Italy;

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Albendazole (ABZ) is the best drug available to treat cystic echinococcosis (CE), a neglected tropical disease. Cystic echinococcosis patients often receive a continuous course of the drug for 6–12 months. In Italy, ABZ shortages occur almost on a yearly basis. We searched clinical records at the World Health Organization Collaborating Center for the Clinical Management of CE in Pavia, Italy, to estimate the amount of ABZ prescribed to patients between January 2012 and February 2017. The cost of ABZ was estimated at €2.25 per tablet based on the current market price in Italy. Patients to whom ABZ had been prescribed were contacted to determine if they had experienced difficulties in purchasing the drug and to assess how such problems affected their treatment. Of 348 identified CE patients, 127 (36.5%) were treated with ABZ for a total of 20,576 days. This led to an estimated cost of €92,592. Seventy-five patients were available for follow-up, 42 (56%) reported difficulties in obtaining ABZ. Of these patients, four (9.5%) had to search out of their region and 10 (23.8%) had to go out of the country. A total of 27 patients (64%) had to visit more than five pharmacies to locate the drug and 10 patients (23.8%) interrupted treatment because of ABZ nonavailability. Shortages in ABZ distribution can disrupt CE treatment schedules and jeopardize patient health.

Author Notes

Address correspondence to Enrico Brunetti, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Brambilla 74, Pavia 27100, Italy and Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Viale Taramelli 5, Pavia 27100, Italy. E-mail: enrico.brunetti@unipv.it

Authors’ addresses: Tommaso Manciulli and Mara Mariconti, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy, E-mails: tommaso.manciulli01@universitadipavia.it and maramariconti@libero.it. Ambra Vola, Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy, E-mail: ambra.vola@gmail.com. Raffaella Lissandrin and Enrico Brunetti, Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy, and Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy, E-mails: raffaella.lissandrin@unipv.it and selim@unipv.it. Marcello Maestri, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy, and Department of Surgery, IRCCS San Matteo Hospital Foundation, Pavia, Italy, E-mail: m.maestri@smatteo.pv.it. Christine M. Budke, Department of Veterinary Integrative Biosciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, E-mail: cbudke@cvm.tamu.edu. Francesca Tamarozzi, Center for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Verona, Italy, E-mail: f_tamarozzi@yahoo.com.

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