Drug distribution performed through hospital pharmacies facilitates public expenditure savings but incurs higher social costs for patients and caregivers. The widespread presence of community pharmacies could support patient access while also improving drug distribution. The implementation of prescriptive data analyses as constrained optimization to achieve specific objectives, could be also applied with good results in the healthcare context. Assuming the perspective of the Italian National Healthcare Service, the present study, built upon existing research in this field, proposes a decision support tool that is able to define which self-administered drugs for chronic diseases should be distributed by community pharmacies, answering to critical challenges in the case of future pandemics and healthcare emergencies, while also providing suggestions for the institutional decision-making process. Moreover, the tool aids in determining the optimal setup of the drug distribution network, comparing centralized (hospital pharmacies) and decentralized (community pharmacies) approaches, as well as their economic and social implications.

Metastatic gastric cancer (mGC) represents an economic and societal burden worldwide. The present study has two aims. Firstly, it evaluates the benefits and the added value of the introduction of trifluridine/tipiracil (FTD/TPI) in the Italian clinical practice, defining the comparative efficacy and safety profiles with respect to the other available treatment options (represented by the best supportive care (BSC) and FOLFIRI (5-FU, irinotecan, and leucovorin) regimens). Secondly, it assesses the potential economic and organizational advantages for hospitals and patients, focusing on third- and fourth-line treatments. For the achievement of the above objective, a health technology assessment study was conducted in 2021, assuming the NHS perspective within a 3-month time horizon. The literature reported a better efficacy of FTD/TPI with respect to both BSC and FOLFIRI regimens. From an economic perspective, despite the additional economic resources that would be required, the investment could positively impact the overall survival rate for the patients treated with the FTD/TPI strategy. However, the innovative molecule would lead to a decrease in hospital accesses devoted to chemotherapy infusion, ranging from a minimum of 34% to a maximum of 44%, strictly dependent on FTD/TPI penetration rate, with a consequent opportunity to take on a greater number of oncological patients requiring drug administration for the treatment of any other cancer diseases. According to experts’ opinions, lower perceptions of FTD/TPI emerged concerning equity aspects, whereas it would improve both individuals’ and caregivers’ quality of life. In conclusion, the results have demonstrated the strategic relevance related to the introduction of FTD/TPI regarding the coverage of an important unmet medical need of patients with metastatic gastric cancer who were refractory to at least two prior therapies, with important advantages for patients and hospitals, thus optimizing the clinical pathway of such frail patients.