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Pharmaeconomics

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Pharmaeconomics

Publié dans : Santé & Médecine
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Pharmaeconomics

  1. 1. PHARMACOECONOMICS PARAMETERS STATISTICS D R . P R E R N A S I N G H J U N I O R R E S I D E N T ( 2 N D Y E A R ) D E PA R T M E N T O F P H A R M A C O LO G Y J N M C A M U
  2. 2. WHAT IS PHARMACOECONOMICS? • Pharmacoeconomics is a branch of health economics which compares the value of one drug therapy to another • Term first coined in 1986 by Townsend • Economic evaluation of pharmaceuticals • Essential to find the optimal therapy at the lowest price
  3. 3. WHY PHARMACOECONOMICS? Cost of drug therapy is increasing • New drugs • Drug preferred over interventions • Irrational prescribing • Increased technology • Increased life expectancy and standard of living • 1979 – 85% drugs were under price control • Now only 15 % are under price control
  4. 4. NEEDFUL IN: Industry - deciding among specific research and development alternatives Government – program benefits Private sector – insurance benefit coverage
  5. 5. PHARMACOECONOMIC ANALYSIS •Involves: oChoosing a perspective oIdentifying and measuring costs oIdentifying and measuring consequences
  6. 6. PERSPECTIVES  Patient perspective – Portion of cost not covered by Insurance Out of pocket expense, indirect cost, Consequence: clinical effect  Provider perspective – eg. Hospitals- Direct costs  Payer perspective – eg. Insurance companies, employers, or the government Direct cost  Society perspective - All direct and indirect costs Mortality morbidity
  7. 7. COST • The value of the resources consumed by a program or drug therapy • Not only drug cost • Direct and indirect cost • Direct- fixed: not influenced by treatment level - electricity, rent variable
  8. 8. COST Direct medical cost • Hospital inpatient • Physician • Outpatient • Emergency department Direct non- medical cost • Transportation • Relocation • Cost of changing diet • Family care Indirect cost • Mortality • Morbidity • Loss of opportunity • Pain • Suffering • Inconvenienc e
  9. 9. INDIRECT COST ESTIMATION • Willingness to pay method(WTP) UNRELIABLE: subjective
  10. 10. CONSEQUENCE • Effects, outputs, or outcomes of the program or drug therapy
  11. 11. • Comparing direct, indirect, and intangible costs with the consequences of medical treatment alternatives Economic outcome • Medical events occur as a result of disease or treatment (e.g., safety and efficacy end points) Clinical outcome • Consequences of disease or treatment on patient functional status such as physical function, social function, general health and well-being, and life satisfaction Humanistic outcome
  12. 12. • Desired effect of a drug Positive outcome • ADR or toxicity of a drug Negative outcome
  13. 13. • Proxy for final outcome • Lipid lowering agent decreasing LDL Intermediate outcome • Reduced MI rate with lipid lowering agents Final outcome
  14. 14. M E T H O D S O F P H A R M A C O E C O N O M I C S
  15. 15. COMPONENTS OF PHARMACOECONOMICS Pharmacoeconomics Economic Cost of illness Cost minimization Cost benefit Cost effectiveness Cost utility Humanistic Quality of life Patient preference Patient satisfaction
  16. 16. COST OF ILLNESS EVALUATION Burden of illness • Estimates overall cost of a particular disease for a defined population – Measuring direct and indirect costs attributable to a specific disease – Not used to compare competing treatment alternatives but to provide an estimation of the financial burden of a disease – Provide baseline to compare prevention or treatment against
  17. 17. COST MINIMIZATION ANALYSIS (CMA) • Most basic technique • Determination of the least costly alternative • Alternatives should be equivalent in safety and efficacy • Consider physician visit, number of hospital days • If drugs A and B are antiulcer agents equivalent in efficacy and adverse drug reactions (ADRs), then the costs of using these drugs could be compared using CMA • Generic drug
  18. 18. COST BENEFIT ANALYSIS • Benefits from a treatment compared with cost of providing it • Compare different programs: neonatal care vs cardiac rehabilitation • Expressed as benefit-to-cost ratio • Ratio >1 treatment is of value- benefit overweigh cost • Ratio <1 not economically beneficial • Valuing benefits in monetary terms is difficult
  19. 19. COST BENEFIT ANALYSIS SERVICE A • Service cost: Rs 100 • Benefit to hospital: Rs 1000 SERVICE B • Service cost: Rs1Lac • Benefit to hospital: Rs10lac Both have B:C ratio 10
  20. 20. COST EFFECTIVENESS ANALYSIS (CEA) • The most commonly employed method • Measures effectiveness (health benefit) in natural units (eg years of life saved, ulcers healed) and the costs in money • Compares therapies with qualitatively similar outcomes • Guide policymakers • Expressed as a ratio either as an average cost-effectiveness ratio (ACER) or as an incremental cost effectiveness ratio (ICER)
  21. 21. COST EFFECTIVENESS ANALYSIS (CEA) • Average cost effectiveness (ACER) = Net Cost / Net Health Benefit • Incremental Cost Effectiveness Ratio(ICER)= (Cost of drug A - Cost of drug B) / (Benefits of drug A – Benefits of drug B) ICER = Difference in costs (A-B) / Difference in benefits (A-B)
  22. 22. COST-EFFECTIVENESS PLANE
  23. 23. COST UTILITY ANALYSIS (CUA) • Drugs/ interventions with different outcomes can be compared • Most appropriate for life extending therapy or serious ADR therapy (cancer chemotherapy) • Modalities decreasing morbidity: arthritis • Cost is measured in rupees and outcome in patient weighted utilities Quality adjusted life year gained One year of health in a disease free patient = 1 QALY DISEASE : lower value
  24. 24. COST UTILITY ANALYSIS (CUA) With treatment X Estimated survival = 10 years Estimate quality of life = 0.7 QALY = 10x 0.7= 7 With treatment Y Estimated survival = 5 years Estimate quality of life = 0.5 QALY = 5x 0.5= 2.5 QALY gained form treatment X 7-2.5 = 4.5 QALY
  25. 25. COST UTILITY ANALYSIS (CUA) • Results of CUA expressed in C:U ratio • Translated to Cost per QALY gained • Preferred treatment is one with low ratio
  26. 26. APPLICATION OF PHARMACOECONOMICS • Policy decision making • Support clinical decision
  27. 27. LIMITS OF PHARMACOECONOMICS • Young science, slowly developing • Process open to bias, in the choice of comparator drug, the assumptions made, or in the selective reporting of results • Studies are conducted or funded by pharmaceutical companies who are interested in the results • Misused as a marketing play
  28. 28. THANK YOU!

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