Lecture 12 - Pharmacoeconomics of T2DM Flashcards
List some of the various types of economic evaluation
- Costing study
• Determining the total cost of a disease (e.g. for the government) - Cost-effectiveness analysis
• Measurement of the outcomes of an intervention (e.g. increase in life-years) and comparison with costs
Example:
• C-E analysis of pharmacological intervention for T2DM
• Intervention cost: $1350
• Health care savings: $800
• Net cost of intervention: $502
• Increase in life expectancy 0.05 life years
• $10,040 per life year gained
Describe the concept of the cost-effectiveness plane
Two axes:
• X axis: effectiveness of treatment
• Y axis: cost of treatment
Four quadrants:
• URH: Drug more expensive and more effective
• ULF: Drug more expensive and less effective
• LRH: Drug less expensive and more effective
• LLH: Drug less expensive and less effective
Describe the concept of a QALY
QALY: Quality of adjusted life year
X axis: life expectancy
Y axis: quality of life
Two lines:
• Health profile w/o intervention
• Health profile w/ intervention
Area between curves:
• QALYs gained
Describe an example of a disease simulation model
Give an example of how this would occur
e.g. Diabetes simulation model
Models progression of disease
Takes into account:
• Risk factors
• Treatments
Captures outcomes in:
• QALYs
• Life expectancy
Indicates a risk for many of the different complications based on many variables:
e.g. Ischemic heart disease
• Age: 1.03
• Female: 0.63
• This means that with every year, there is a change of +1.03 in risk of IHD
Based on this, a clinician can calculate the risk of various complications based on the profile of the individual with the disease
Process: 1. Define the health profile of the individual: • Age • Ethnicity • Sex • BMI etc.
- Commence yearly model cycle
- Randomly order and run event equations
• This delivers likelihood (% chance) of all the various complications
• e.g. 1% chance of CHF (chronic heart failure) - After a year, the measurements are taken again and the model is updated
- Calculation of benefit measures after a year:
• QALYs
• Life years
Why are simulation models used?
There are many ‘what ifs’ associated with diseases (e.g. DM)
Many factors that need to be taken into account:
• Co-morbidity
• Treatment
• Factors (e.g. BP, kidney function)
Simulation models allow one to evaluate the impact of interventions on the progression of the disease
Describe applications of simulation models, e.g. the UKPDS Diabetes model
- Clinical trials
The model can be used in clinical trials of drugs
i.e. compare the progress of the disease in the control and treatment groups
Compare the cost of Atorvastatin in Australia, NZ and the UK
Australia: $52
UK: $2
NZ: $3
This is evidence that intervention costs may vary
What are most health costs in T2DM due to?
A high proportion of health costs of T2DM are due to complications
Compare prevalence of various T2DM complications in different countries
What is the implication of this?
Different countries (ethnicities) have different prevalences of complications:
Asia: high rates of stroke
UK, US, AUS: higher rates of major coronary complications
Implication:
• Models need to be different in different countries / for different ethnicities
Compare ‘Quality of life’ difference in different countries
There is considerable regional variation in perception of quality of life
Asia: report less problems
E. Europe: report most problems
US, UK, AUS: somewhere in the middle
List reasons why models need to be adapted for different countries / ethnicities
- Different cost of medication
- Different frequencies of complications
- Different perception of quality of life
Describe the ‘patent cliff’
We are currently ‘falling down a patent cliff’
Many drugs developed 20 years ago are coming off their patents and becoming generic
This will see the reduction in the cost of drugs
Describe the features of technology change
What does this mean for the pharmaceutical industry
As time progresses, technologies become better and cheaper
Prices can decline to <2% of the initial price
For the industry:
• Low cost generic drugs
• Drugs for treating GP, BP and cholesterol are now affordable in many countries
What is the implication of lower cost pharmaceuticals?
Need to rethink guidelines of ‘when to treat’
Cheaper drugs means a shift in the cost-benefit analysis
e.g. Statins
• Cheaper statins mean that use could be opened up to individuals who have high risk, but were previously not indicated
e.g. Metformin
• Shown to be prevent diabetes
e.g. BP drugs
• Shown to be effective at reducing mortality
