Pharmacoeconomics Flashcards
What is the definition of pharmacoeconomics? What is the focus on? What does it address?
The field of study that evaluates the behaviour or welfare of individuals, firms, and markets relevant to the use of pharmaceutical products, services, and programs
- Focus is on inputs (costs) and outputs (outcomes)
- Addresses clinical, economic, and humanistic aspect of health care interventions
Define these key concepts and terminology;
A) Efficiency
B) Opportunity cost
C) Incremental analysis
D) Sensitivity analysis
A)
- Obtaining maximum benefit (i.e. health gain) from limited resources
B)
- “Benefit foregone when selecting one therapeutic alternative over the next best alternative” –> cost incurred by not enjoying the benefit associated with the best alternative choice
C)
- The ‘additional’ costs and benefits that arise as a consequence of using new drugs compared to existing drugs
D)
- Explores the extent to which study conclusions are dependent on underlying assumptions or data that may be subject to error
Define these three terms for costs;
A) Direct
B) Indirect
C) Intangible
A)
- Not just drug costs!
- All costs paid directly by the ‘payer’ (e.g. health service - including staff costs, capital costs, etc.) – medical services, procedures, hospital admissions, etc.
B)
- Costs experienced by the patient (or family or friends) or society
- May include loss of earnings, productivity, leisure time, or cost of travel to hospital, etc.
C)
- Pain, worry or other distress
Pharmacoeconomics takes into account costs vs benefits. Costs has been spoken about above. What are benefits and define the following terms of benefits;
A) Natural
B) Associated economic benefit
C) Utility
Aims to incorporate all of the impacts upon the patient’s life that arise as a consequence of drug therapy –> may be reported by patient, carer, clinician, or physiological
A)
- Years of life saved, strokes prevented, cancers cured, hospital admissions prevented, etc.
B)
- Includes, for example, economic benefits to society because of a patient’s health improving sufficiently to return to work
C)
- Changes in patient satisfaction or sense of well-being, patient preference
For benefits;
A) What is Quality Adjusted Life Year (QALY)? What is it derived from?
B) What 1 QALY equivalent to
C) What can QALYbe calculated for?
D) What type of method results in QALY benefit measurement?
A)
- Summary of quality and quantity of life – i.e. measure of disease burden
- Derived from the length of time (in years), multiplied by the utility (full health utility = 1)
B)
1 QALY = 1 year in ‘full health’
- 0.3 QALY = 0.3 years in full health or 1 year at 30% of full health (utility = 0.3)
C)
- QALYs an be calculated for any condition or disease, so useful for comparing one disease with another
- Utility derived from validated questionnaires
> Non-specific (EQ-5D, SF-36) or disease state-specific
> Other methods - Time Trade-Off (TTO) or Standard Gamble
D)
- Cost-utility
Compare pharmacoeconomic analyses by the different methods (cost-minimisation, cost-effectiveness, cost-utility, cost-benefit)
What is ICER? What is the formula?
Incremental cost-effectiveness ratio
For ICER;
A) What happens to interventions in Q3 and Q4?
B) What happens to interventions in Q1 and Q2?
A)
- Rejected or dominated
B)
- Accepted or dominant
Who assesses both clinical effectiveness and cost-effectiveness for PBS subsidization?
Pharmaceutical Benefits Advisory Committee (PBAC)
- Economics Sub-Committee (ESC) advises on cost-effectiveness policies and evaluates cost-effectiveness aspects of major submissions to the PBAC
- 12 health economics/clinical experts (public health, pharmacy, epidemiology, etc.) + 1 pharmaceutical industry representative
- Healthcare system perspective adopted
- Does not generally accept cost-benefit analyses alone
- Final decision made by Minister for Health
Is there a threshold for funding new medicines? What price of an ICER per QALY is more likely to be recommended?
No specific threshold for funding new medicines
- However, a new drug with an ICER < $50 000 per QALY gained is more likely to be recommended.
- Uncertainty of ICER and timeframe considered
- Other factors (e.g. clinical need, equity) also considered