Week 2: Pharmacoeconomics (missing lecture) Flashcards
Pharmacoeconomics
-cost, intervention, outcomes
-description and analysis of costs and consequences of pharmaceuticals and related services
-identify/measure costs, risks, benefits of tx
-determine outcomes from perspective of pt, healthcare or SOCIETY
why is pharmacoeconomics important?
-US spends inc most on health with inc worse outcomes
-drugs expensive
-trade-off considerations on how to spend resources
most expensive meds in US
-Zolgensma (tx spinal atrophy)
-Zokinvy (tx rare aging disease)
-Danyelza (cancer tx)
-all over $1 mil for duration of therapy
Four types of costs
-direct medical (rx, dr, hospital)
-direct non-medical (transportation, baby sitting, food/lodging out of town)
-indirect (loss of productivity)
-intangible (suffering, anxiety)
Who bears the burden of healthcare costs? (perspectives)
-patient
-institution (most common)
-payer (more common, can be patient)
-society
society perspective
-if cost is relevant to patient, payer or instituition it will be relevant to society
types of pharmacoeconomic analysis
-cost-minimization analysis (CMA)
-cost-benefit analysis (CBA)
-cost-effectiveness analysis (CEA)
-cost-utility analysis (CUA)
-cost measured in dollars
-based on method to assess outcomes
Cost-minimization (CMA)
-compare costs of interventions with same outcomes
-ex: brand vs generic
-cost of drug + prep cost + admin cost(qd vs BID) = total cost of drug
-cost measured in $$
CMA measures
-cost in $
-don’t need to measure outcomes
-ONLY useful when outcomes are equal tho
Cost-benefit analysis
-measure cost of interventions and outcomes in $$
-determines which tx has best monetary benefit
-must assign $ amount to outcome tho
CBA measurement unit
-cost and outcome in $$
-kinda hard to do, have to put a dollar amount on suffering
Cost-effectiveness analysis (CEA)
-measure outcomes in natural health units (# cured, lives saved, years saved)
-which tx achieves outcome at lowest cost
-need to be same unit of measure for outcomes
-most common
-ICER
cost-effectiveness analysis measures
-cost in $$
-outcome in natural health units
incremental cost-effectiveness ratio (ICER)
($ of drug A - $ drug B)/(outcome A - outcome B)
Cost-utility analysis (CUA)
-measures outcomes in terms of quality of outcome
-cost and value
-value = cost + quality
-referred to as utility units
-use pt preferences or funtional status
-most commonn outcome is quality-adjusted life years
-accounts for quantity and quality
-not precise
-viewpoint may lead to bias
QALY (CUA)
-accounts for quantity and quality of life generated by intervention
-four years in health state 75% = 4*0.75 = 3 QALYs
-four years at 50% health = 2 QALYs
CUA utility scores
-perfect health 1
-death: 0
-severe angina 0.53
-breast cancer (removed): 0.8
-cancer spread: 0.16
use ICER in CUA
-QALYs on bottom
Cost-effectiveness threshold
-$100-150k per QALY threshold as basis for recommending value-based drug prices
Role of pharmacist in pharmacoeconomics
-evaluate pharmacoeconomic lit
-apply results to clinical decision making (pt, formulary, resources)
-assist in design and implementation of research studies
Evaluating studies
-evaluate the question
-determine perspective
-alternatives
-study design
-type of analysis concluded
-all important costs and outcomes included
-any important costs or consequences not included
-was discounting utilized appropriately
-are all assumptions stated
-summary/conclusions
Outcome measurement unit of each analysis
-CMA: not measured (assumed equivalent)
-CBA: $$
-CEA: natural units
-CUA: QALYs
