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Article History

First Online: 21 June 2019

Compliance with Ethical Standards

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: The study was conducted in the context of the “Assessment of Short and Long Term Risk–Benefit Profile of Biologics Through Healthcare Database Network in Italy” project coordinated by the University of Messina, funded by the Italian Ministry of Health. Only public researchers of the local and regional health authorities or academia were involved in the study.

: Rosa Gini discloses a personal interest in sustainability of universal healthcare systems. Valeria Belleudi, Francesco Trotta, Antonio Addis, Ylenia Ingrasciotta, Valentina Ientile, Michele Tari, Maurizio Pastorello, Salvatore Scondotto, Pasquale Cananzi, Giuseppe Traversa, Marina Davoli and Gianluca Trifirò declare no conflict of interest.

: GT, FT, VB, AA, RG, MD and GTra conceived the study. FT, VB, GT, AA and RG designed the study. FT, RG and VB analysed the data. FT and VB wrote the manuscript. MT, MP, SS, PC and RG provided the data and were responsible for their quality. All authors saw, commented and approved the final version of the paper. GT and MD are the guarantors.

: Ethical approval was achieved from regional and local health authorities.