Intro to Pharmacoeconomics

Question 1

Pharmacoeconomics

Answer 1

description and analysis of the costs and consequences of pharmaceuticals and related services
process of identifying, measuring, and comparing the costs, risks, and benefits of programs, services, or therapies
determining the outcomes from the perspective of pts, the HC system, or society

Question 2

Health consumption expenditures comparison between US and comparable country avg

Answer 2

US spends way more on health care than anyone else as a percent of gross domestic product
however, our life expectancy is lower than the comparable country average “not getting the bang for our buck”

Question 3

Why is this important

Answer 3

HC costs increasing - US spends more
HC outcomes are declining in US
drug are expensive
trade off considerations on how to spend resources

Question 4

Classifying costs

Answer 4

calculated to estimate the resources used in the production of an outcome
four types of costs: direct medical costs, direct non-medical costs, indirect costs, intangible costs

Question 5

Direct medical costs

Answer 5

medical costs for providing treatment
ex. cost of meds, physician visits, hospitalizations

Question 6

Direct non-medical costs

Answer 6

costs to patients/family directly associated with treatment, but not medical in nature
ex. cost of transportation to clinic, babysitter, food/lodging if out of town

Question 7

Indirect costs

Answer 7

costs that result from loss of productivity because of illness or death
do not involve a transfer of money
ex. missed work or school days, decreased productivity

Question 8

Intangible costs

Answer 8

costs of pain, suffering, anxiety, or fatigue due to an illness or treatment of an illness
difficult to measure and assign value

Question 9

Types of perspective

Answer 9

patient, institution, payer, society
perspective described whose costs are relevant based on the purpose of the pharmacoeconomic study

Question 10

Pharmacoeconomic analyses

Answer 10

four types: cost minimization analysis (CMA), cost-benefit analysis (CBA), cost-effectiveness analysis (CEA), cost-utility analysis (CUA)
cost measured in $
categorized based on method to assess outcomes

Question 11

Cost minimization analysis

Answer 11

used to comapre costs of interventions with equivalent clincial outcomes
ex. generic vs brand name drug; drug A vs drug B assuming equal efficacy and safety

Question 12

How do you measure the total direct costs of a drug

Answer 12

drug A vs drug B assuming equal efficacy and safety
cost of drug + cost of preparation + cost of administration = total cost of drug

Question 13

CMA cost measurement unit and outcome measurment unit

Answer 13

cost measurment unit: $$
outcome measurement unit: not measured, assumed to be equivalent

Question 14

CMA advantages and disadvantages

Answer 14

advantages: simplicity, no assessment of outcome
disadvantages: only useful when outcomes are equal

Question 15

Cost benefit analysis

Answer 15

measures costs of interventions and outcomes in monetary units
determines which intervention provides the best monetary benefit: can be used to compare diff drugs or services for diff outcomes
must assign monetary outcome to clinical endpoints: ex. what’s the cost-benefit of a pharmacy service compared to usual medical care on reducing BP

Question 16

CBA cost measurement unit and outcome measurement unit

Answer 16

cost measurment unit: $$
outcome measurement unit: $$

Question 17

CBA advantages and disadvantages

Answer 17

advantages: allows comparison of interventions with diff outcomes
disadvantages: requires assigning monetary value to pain, suffering, life

Question 18

Cost effectiveness analysis

Answer 18

measures outcomes in natural health units: ex. infections cured, lives saved, # of life years saved
determines with intervention achieves a given objective at the lowest cost: used to compare diff interventions using same measured outcome
most common type of analyses

Question 19

Incremental cost-effectiveness ration (ICER)

Answer 19

additional cost required to obtain the additional effect gained by switching from drug A to B
ICER = (total cost of drug A - total cost of drug B)/(outcome of drug A - outcome of drug B)

Question 20

CEA cost measurment unit and outcome measurement unit

Answer 20

cost measurement unit: $$
outcome measurement unit: natural related units

Question 21

CEA advantages and disadvantages

Answer 21

advantages: outcomes measured in units that are understanable to many clinicians; no need to convert outcomes into dollar amoung
disadvantages: outcomes must be measured in same units; length of life is not the same as quality of life

Question 22

Cost-utility analysis

Answer 22

measures the outcomes in terms of the quality of the outcome produced
examines the cost of an intervention and the value of the outcome: value = cost + quality
referred to as utility units: often uses pt preferences or functional status; most common outcome is quality-adjusted life years

Question 23

QALY takes into account

Answer 23

both the quantity and the quality of life generated by HC interventions
product of life expectancy and a measure of the quality of years remaining: 4 years in health state 75% –> 4(0.75) = 3 QALYs

Question 24

CUA cost measurment unit and outcome measurement unit

Answer 24

cost measurment unit: $$
outcome measurement unit: quality-adjusted life years or other utility measures

Question 25

CUA advantages and disadvantages

Answer 25

advantages: accounts for both quantity and qaulity of the outcome
disadvantages: not a precise measure, viewpoint may bias outcome measures

Question 26

Role of the pharmacist

Answer 26

evaluating pharmacoeconomic literature
apply results to clinical decision making: individual pt care, formulary/utilization management, resource allocation/price setting
assist in design/implementation of research studies