10/10 Flashcards
Pharmacoeconomics
Assesses the overall value of pharmaceutical interventions and provides info critical to the optimal allocation of health resources
Cost analysis: cost and pharmaceutical product or service
Clinical or Outcome study: pharmaceutical product or service and outcome
4 Types of Pharmacoeconomics Studies
The cost measurement unit for each is dollars but the outcome measurement is different
- Cost minimization analysis: assumed to be equivalent in comparable groups
- Cost effectiveness analysis: natural units like life years gained or mM blood glucose
- Cost utility analysis: quality adjusted life years or other utility
- Dollars or monetary units
Cost minimization analysis
Outcomes of two or more interventions are assumed to be equivalent, only compare cost of intervention
Example: look at costs for inpatient vs. outpatient birth delivery, cost comparison of two generic drugs
Not appropriate for different classes of drugs
Advantage: simplest to conduct
Disadvantage: can’t use when outcomes are different
Cost effectiveness analysis
Outcomes are measured in natural units like mmHg blood pressure change
Average CER: cost of intervention / effectiveness of intervention
Incremental CER: (cost of intervention B -cost of intervention A) / (effectiveness of intervention B - effectiveness of intervention A)
Example- HPV vaccine vs. screening
Only perform when outcome of one intervention is better but more expensive
Advantages: outcomes easily quantified and familiar
Disadvantages: interventions with different types of outcomes can’t be compared, only do one important outcome, requires judgment call
Cost Utility Analysis
Quality adjusted life year is on a scale from 0-1
Example- HPV screening taking into account effects of cancer
Effective if incremental cost utility ratio is below $50 or 75k
Not used when quality of life is similar but quantity is different
Advantages: has both mortality and morbidity
Disadvantages: no consensus on calculating utility
Cost Benefit Analysis
Measures: net benefit, benefit to cost ratio, internal rate of return, break even point
Example: pharmacy bar code scanner, asthma or anticoagulation clinic
Essential elements of a pharmacoeconomics study
- Have 2+ interventions
- Incremental analysis of costs and outcomes
- Perspective: societal, payer, or patient
- Discounting of costs and benefits
- Sensitivity analysis
Lynch Syndrome
MSH2 and MLH1 are big, also MSH6 and PMS2
Autosomal Dominant, Problem with DNA mismatch repair
Early age for colorectal cancer diagnosis, hereditary with few polyps, tumors on right side
Also includes endometrium, uterine, and ovarian cancers
Lynch Syndrome Testing
Microsatellite instability: in most but some in sporadic
Immunohistochemistry: loss of protein stain indicates possibility of mutation (or methylation), can do direct gene testing like on MLH1
Lynch Syndrome Screening
Colonoscopy at 20-25, do every 1-2 years, age 30 if MSH6/PMS2 carriers
Transvaginal ultrasound and endometrial aspirate at 30-35, testing after child bearing
Constitutional Mismatch Repair Deficiency Syndrome
Mutations in both alleles of he same mismatch repair gene
Autosomal recessive
Childhood presentation of cancers: hematologist malignancies, brain tumors, colon cancer
Hereditary Breast and Ovarian Cancer Syndrome
Early onset breast cancer, ovarian cancer, bilateral breast cancer, male breast cancer
Ashkenazi Jewish heritage
Mutations in BRCA1/2, tumor suppressor genes that repair dsDNA breaks
Autosomal Dominant
Start breast screenings earlier, chemoprecention with Tamoxifen
Genetic Information Nondiscrimination Act
Health insurers cannot use genetic info for eligibility or premiums, also can’t make do genetic test, can discriminate only if have disease
Employers can’t discriminate against you in any way or make you get tested, small employers with less than 15 people don’t count
Doesn’t apply to federal stuff like with military, life insurance, disability
Duty to Warn
Places patient confidentiality above duty to warn others in US legal system
Warn if: pro relationship with person that may cause harm / potential victim, person at risk is identifiable, harm is foreseeable and serious
Court Cases
Pate v. Threlkel: woman with MTC sue since mom’s doc not warn her of autosomal dominant disease, court say duty to warn but can do so by informing patient of possible risk to relatives
Safer v. Estate of Pack: daughter with Familial Polyposis say doc should have warned her after father test, court say duty to warn not satisfied by informing patient of risk to relatives, say need to take reasonable steps to guarantee immediate relatives are warned
HIPPA Law: protect patent medical info except when serious/imminent threat to public/3rd party, and the doc has the capacity to avert that harm
