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PHARMACOECONOMICS
Jinender Kumar
Pharmacoeconomics Research Uses of Pharmacoeconomics Research Need for Pharmacoeconomics Research Types of Pharmacoeconomics Research Sensitivity Analysis Discounting Journals References
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PHARMACOECONOMICS RESEARCH Sub-discipline of health economics compares the costs (i.e resources consumed)
and consequences (i.e economic, clinical and humanistic) of the drug therapies and medical interventions
PE analysis efficient allocation of limited resources among
competing alternative medications and services
VALUE
Health Outcome
Cost
USE OF PHARMACOECONOMIC RESEARCH Pharmaceutical reimbursement Selecting formulary products Price Negotiations Clinical Practice Development guidelines Communication to prescribing physicians
NEEDS TO MONITOR VALUE OF PHARMACEUTICALS Increased cost. Increased number of alternatives available to
treat illness and disease. Growing demand for pharmaceuticals. Introduction of high cost biotechnology
products.
TYPES OF PHARMACOECONOMIC EVALUATION Cost-minimization analysis (CMA) Cost-benefit analysis (CBA) Cost-effectiveness analysis (CEA) Cost-utility analysis (CUA) Cost-consequence analysis (CCA)
COMPARING PHARMACOECONOMIC METHODOLOGIES
METHODOLOGY
Cost-Minimization
Cost-Effectiveness
Cost-Benefit
Cost-Utility
Cost-Consequence
CONSEQUENCES
Natural Units
Natural Units
Dollars
Quality-Adjusted Life Years (QALYs)
Natural Units, Dollars or
QALYs
STEPS FOR CONDUCTING A PHARMACOECONOMIC EVALUATION Defining the problem and stating the
objective. Identifying the perspective and alternative
interventions to be compared. Identifying and measuring the outcomes of
each alternative. Identifying, measuring and valuing the costs
of all alternatives.
DEFINE THE PROBLEM AND STATE THE OBJECTIVE All pharmacoeconomic evaluation should
have a clear and concise statements of problem or question to be addressed.
e.g. What is the most cost-effective regimen for the treatment of type II diabetes?
PERSPECTIVE
Point of view from which the study is taken Determines what will be measured, what are
the costs and benefits, and how they will be valued
Guides and limits application of study results What are the possible perspectives in PE
studies?
PERSPECTIVE
Pharmacoeconomic evaluation can be conducted from several different perspectives including the employer, the patient, the health insurance plan, society, or the government.
IDENTIFYING ALTERNATIVE INTERVENTIONS Which alternative should be compared in
pharmacoeconomic evaluation?
IDENTIFYING ALTERNATIVE INTERVENTIONS Alternatives should be compared only when
one of the alternatives is either more costly or more effective.
IDENTIFY AND MEASURE OUTCOMES OF EACH ALTERNATIVE INTERVENTIONSome of the outcomes of the treatment are: A cure (health is restored) Improved quality of life Decreased incidence of morbidity Extended life Relief or reduction in symptoms No effect Increased morbidity Mortality
OUTCOMES
Both positive and negative outcomes should be addressed
Positive outcomes: drug’s efficacy measure Negative outcomes: ADR and treatment
failure
IDENTIFYING,MEASUREMENT AND VALUATION OF COSTS
From the measurement aspect, two components are costs and consequences
Three important concepts related to costs are identifying, measuring, and placing a value on resources or costs.
IDENTIFYING RELEVANT COSTS What is cost?
How is cost different from price?
COSTS
Direct costs: costs to deliver services to patient; both medical and non-medical
Indirect costs: cost of treatment to patient or society
Intangible costs: quality of life
Costs can be described in many ways Cost / unit (cost/tab, cost/vial) Cost / treatment Cost / person Cost / person / year Cost / case prevented Cost / life saved Cost / DALY (disability-adjusted life year)
MEASURING COSTS
After cost identification the next step involves measuring the costs.
Measurement involves counts of resources consumed in units depending on the type of costs.
VALUING COSTS
After cost measurement, the next step involves placing a dollar value on the resources.
SENSITIVITY ANALYSIS
Test key outcome or cost assumption of an analysis to determine how sensitive the results are to variation or to uncertainty.
In pharmacoeconomic evaluations, the accuracy with which costs can be identified, measured, or valued will vary.
DISCOUNTING
The purpose of discounting is to present all costs in their present value and to incorporate the society’s time preference for money.
Alternatives that have costs or benefits realized at different times should be discounted to a present value to make valid comparisons.
JOURNALS
Value in Health Pharmacoeconomics Health Economics Pharmacoeconomics and Outcomes News Clinical Therapeutics - Pharmaceutical
Economics & Health Policy Health Affairs (The Policy journal)
REFERENCES
1. http://ispor.org/Terminology/Default.asp
2. Bootman JL, Townsend RJ, Mcghan WF. Principles of Pharmacoeconomics. 3 rd edition. Harvey Books Company. 2005.
3. McCArthy Rl, Schafermeyer KW. Introduction to Health Care Delivery. 3rd edition. Jones and Barlett Publisher. 2004.
4. Bonk RJ. Pharmacoeconomics in Perspective:a primer on reseach, techniques and perspective. Pharmaceutical product press. 1999.
5. Rychlik R.Strategies and Pharmacoeconomics and Outcomes Research. Pharmaceutical Heritage Edition. 2003.
6. Vogenberg FR. Introduction to Applied Pharmacoeconomics. Mcgraw-Hill Publications. 2001.
ASSIGNMENT
Prepare a short report on each type of pharmacoeconomics analysis. How each type of PE analysis is defined? What perspectives can be taken in each type of PE
analysis ? How CER, CBR, and CUR are defined? How ICER, ICBR, and ICUR are defined? What type of data can be used to conduct PE analysis ? What are different study designs to conduct PE
analysis? Examples of each type of PE analysis.