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Rajkot
Department of Pharmacology, SJTPC,
Over the past few years, the
study of PE has experienced
an extraordinary boom within
the health care sectors.
Why?
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Initially the decisions regarding the use of
medical intervention was based on clinical safety,
efficacy, and quality of the intervention used (old
paradigm).
But this scenario was suddenly changed into a
different setting which mainly concerned about
Rajkot
Department of Pharmacology, SJTPC,
the cost of the intervention (new paradigm).
Rajkot
Department of Pharmacology, SJTPC,
(resources used) and consequences (clinical,
economic, humanistic).
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Questions that pharmacoeconomics may
help to address are as follows:
Rajkot
Department of Pharmacology, SJTPC,
Which is the ideal drug for pharmaceutical
manufacturers to develop?
Which drug delivary system is the best for the
hospital?
How do two clinical pharmacy services compare?
What is the cost per quality adjusted year of life
extended by a drug?
Will patients quality of life be improved by a
particular drug therapy decision?
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What is the best drug for particular disease?
For better understanding consider one
scenario:
Rajkot
Department of Pharmacology, SJTPC,
Suppose, you are a clinical pharmacist, member of
Pharmacy and Therapeutic Committee at a
hospital, and have been given responsibility to
evaluate a new beta blocker product for addition
to the hospital drug formulary.
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In clinical setting:
The consideration must be given to;
Therapeutic effectiveness of the agent for patient
subpopulation,
Impact of therapeutic agent cost or impact on
Rajkot
Department of Pharmacology, SJTPC,
pharmacy budget,
Quality of life.
In industrial setting:
The consideration must be given to;
All the criteria which are having impact on
clinical setting,
Competition with other companies and impact of
drug in market 8
2.TYPES OF PHARMACOECONOMIC
EVALUATIONS:
Rajkot
Department of Pharmacology, SJTPC,
Cost-Effectiveness Analysis (CEA):
Rajkot
Department of Pharmacology, SJTPC,
Example-1: CARBOPLATIN & CISPLATIN (In
the treatment of ovarian cancer)
Example-2: Comparision of two prescription, one
of which consist of Generic company product
while other is Brand leader. (Molpara and
Crocin)
LIMITATION:
Outcomes must be equivalent for analysis. 10
2.2) Cost-Effectiveness Analysis (CEA):
Rajkot
Department of Pharmacology, SJTPC,
measured in monetary terms (Rupees) but
the outcomes are measured in natural unit
changes in health (life years increased or
number of side effects decreased).
Additional benefit is worth even if the cost is
more.
Rajkot
Department of Pharmacology, SJTPC,
2) ICER (Incremental Cost-Effectiveness Ratio)
ICER= Diff. in cost/Diff. in benefits
Example 1:
Rajkot
Department of Pharmacology, SJTPC,
Comparison of four lipid lowering
agent/program:
No drug treatments or dietary modifications-No
Pharmacological program
Drug-A
Drug-B
Drug-C (1)
Drug-C (2) 14
Four measures of effectiveness:
Rajkot
Department of Pharmacology, SJTPC,
iv) Triglycerides
Rajkot
Department of Pharmacology, SJTPC,
deep vein thrombosis (DVT) and pulmonary
embolism (PE).
VTE is responsible for appx. 2,50,000
hospitalization in US each year.
20% of people with accute PE present with
sudden death, 30% of people with VTE
syndromes die within 30 days.
Direct costs of VTE reaches appx. 3-4 billion
dollars annualy. 16
Depending on treatment for VTE, there are
additional costs potentially associated with
therapeutic monitoring.
Furthermore, management of potential side
effects of anticoagulants, including bleeding
and heparin induced thrombocytopenia
Rajkot
Department of Pharmacology, SJTPC,
(HIT) are very expensive.
Cost related to long-term complications of VTE,
including clot recurrence and post
thrombotic syndrome.
A recent cost-effective analysis determined that
use of Fondaparinux for initial DVT therapy
may offer substantial cost savings relative to
Enoxaparin.
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TABLE-1
MODEL INPUTS FOR RATES OF VENOUS
THROMBOEMBOLISM (VTE) RECURRENCE, MAJOR
BLEEDING, AND HEPARIN-INDUCED
THROMBOCYTOPENIA,AND ASSOCIATED COSTS PER EVENT.
Rajkot
Department of Pharmacology, SJTPC,
18
TABLE: 2
RESULTS OF BASE-CARE COST-EFFECTIVE ANALYSIS
OF FONDAPARINUX VERSUS ENOXAPARIN FOR
TREATMENT OF DEEP VEIN THROMBOSIS (DVT)
Rajkot
Department of Pharmacology, SJTPC,
From these data it is concluded that Fanoparinux offers
greater advantage in DVT compared to other agents.
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LIMITATIONS:
Rajkot
Department of Pharmacology, SJTPC,
CEA can measure only one measure of
effectiveness.
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2.3) Cost-Utility Analysis (CUA):
Rajkot
Department of Pharmacology, SJTPC,
The main advantage of CUA as compared to
traditional CEA is that it can combine more
than one measure of effectiveness or both
measures of morbidity and mortality into a
single measure.
Example:
Rajkot
Department of Pharmacology, SJTPC,
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QALY gain from treatment 7-2.5=4.5 Years
Rajkot
Department of Pharmacology, SJTPC,
To achieve QALY total ` 18,000 need to be spend.
Therefore, per year ` 4,000 is the cost of X drug.
Now, drug X is compared with drug Y, in terms
of total cost and QALY gained from the
treatment.
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LIMITATION:
Rajkot
Department of Pharmacology, SJTPC,
The only limitation of CUA is that it should not
be applied when single intermediate outcome is
enough to measure effectiveness of therapy.
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2.4) Cost-Benefit Analysis (CBA):
Rajkot
Department of Pharmacology, SJTPC,
Benefits are measured using contingent valuation
or willingness to pay method (WTP).
Rajkot
Department of Pharmacology, SJTPC,
LIMITATION:
CBA is difficult to perform because it requires both
cost and benefits to be measured in monetary
terms
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2.5) Cost-of-Illness Evaluation (CIE):
Rajkot
Department of Pharmacology, SJTPC,
By evaluating the humanistic impact of
disease and resources used in treating a
condition prior to discovery of a new intervention,
the pharmacoeconomist can effectively establish
a baseline for comparison.
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2.6) Cost-Consequences Analysis (CCA):
Rajkot
Department of Pharmacology, SJTPC,
life adjusted years or cost-effectiveness
ratios.
Rajkot
Department of Pharmacology, SJTPC,
intervention and has an advantage of being
more readily understandable and more likely
to be applied by healthcare decision-makers.
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`
LIMITATIONS:
Rajkot
Department of Pharmacology, SJTPC,
makers level might not be made in patients
or societys best interests.
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3. TYPES OF INPUTS AND OUTPUTS
IN PHARMACOECOMONIC STUDIES:
Inputs:
Healthcare Sector (C1):
Rajkot
Department of Pharmacology, SJTPC,
Cost of providing care by the program (i.e.
organizing and operating costs within the
health sector). It also include continuing care
(Hospitalization).
Patient and Family (C2):
Out of pocket cost, co-payment cost, cost due to
time spent in treatment/unemployement.
External costs (C3):
This category includes all resources consumed
in other sectors (Other than healthcare sector 31
Rajkot
Department of Pharmacology, SJTPC,
E: Physical effects in natural units for e.g.,
number of lives saved, number of deaths prevent,
number of disability days reduced.
H: Humanistic outcome.
V: Changes in health related quality of life
measures (HRQOL) and other values.
U: QALY (Quality adjusted life-years) based on
valuation of health state preferences
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W: Willingness to pay or Contingent valuation
W: Global willingness to pay
Cost-Minimization Analysis (CMA):
(C1-S1) Or (C1+C2+C3)-(S1+S2+S3)
PHARMACOECONOMIC
4. EQUATIONS FOR
Rajkot
Department of Pharmacology, SJTPC,
(C1-S1)/E; [(C1+C2+C3)-(S1+S2+S3)]/E
Rajkot
Department of Pharmacology, SJTPC,
&
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RNDr. Marta Megyesiov
Rajkot
Department of Pharmacology, SJTPC,
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