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<h3>Background and Importance</h3> Life expectancy reached 73,4 years in 2023, increasing the need for elderly care. Nursing home residents typically require medications due to comorbidities, resulting in higher daily consumption compared with community-dwelling older adults. <h3>Aim and Objectives</h3> This study analysed drug consumption in nursing homes across different healthcare management areas. <h3>Material and Methods</h3> Data from January-December 2024 obtained from the national healthcare service database were analysed. Nursing homes were classified by size (<25 beds, 25–100 beds, and >100 beds) and by territory. Statistical analyses evaluated relationships among medication pack prices, total drug costs, consumption levels, net expenditure, number of patients and cost per patient. <h3>Results</h3> The study included 75.302 patients from nursing homes: 9% from <25 beds (n = 6.437), 58% from 25-100 beds (n = 43.807), and 33% from >100 beds (n = 25.058). The average cost per bed was 1.424,53€ and per patient 1.167€. The mean cost per medicine pack was 14,47€, consistent across the territory (14–16€) and 20,9–38,2% higher than in community pharmacies (11,58€). No significant correlation was observed between average pack cost and total costs: <25 beds (r=-0,04), 25-100 beds (r=0,38) and >100 beds (r=0,35). Total costs were driven mainly on the number and complexity of patients rather than pack cost. Net expenditure depended on the number of patients and cost per patient. Interannual analysis showed that changes between 2023 and 2024 were explained by increased total cost per patient (<25 beds: r=0,72, 25-100 beds: r=0,65, >100 beds: r=0,80), whereas total 2024 expenditure was strongly associated by number of patients (r=0,99 for all types). Drug consumption patterns showed contrasting trends: antibiotic use increased with size (49,85% in <25 beds to 54,60% in >100 beds), while antipsychotic use decreased (49,70% to 44,75%). One-tailed t-tests revealed significant differences between <25 and >100 beds for antibiotics (p=0,031) and antipsychotics (p=0,046), while <25 vs 25-100, and 25-100 vs >100 comparisons were not significant (p>0,05). <h3>Conclusion and Relevance</h3> Territorial analysis demonstrated significant variability in drug costs across different healthcare management areas, independent of nursing home size. However, drug consumption patterns differed by facility size, with opposite trends observed for antibiotic and antipsychotic use. <h3>Conflict of Interest</h3> No conflict of interest