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Oksana Yakovlevna Mischenko INTRODUCTION TO PHARMACOECONOMICS. PHARMACOECONOMIC CATEGORIES AND PARAMETERS Topic № 1 NATIONAL UNIVERSITY OF PHARMACY DERPATMENT FOR PHARMACOECONOMICS

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Theoretical questions: Preconditions of occurrence pharmacoeconomics as applied science Subject, purpose of pharmacoeconomics Development of pharmacoeconomic researches Parameters of pharmacoeconomic evaluation of medical products and of medical interventions Interrelation pharmacoeconomics with pharmaceutical, medical and economic disciplines Role of pharmacoeconomic in practical activities of pharmacists consumers of pharmacoeconomic results

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Тне features of health care in different countries are: Governments worldwide are spending more money on healthcare than on nearly anything else. These worldwide expenditures increase at a faster rate than the global gross domestic product. Pharmaceutical expenditures, which constitute a large part of healthcare expenditures, have been increasing much faster than total healthcare expenditures.

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The expenditures on health care system in different countries of the would, % from gross domestic products USA Switzerland France Germany Canada Portugal Norway Greece Netherlands Italy Spain UK Japan

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the preventive actions directed on the prevention the diseases are absence, etc.) The main factors, wich increace healthcare expenditures, are: aging population the cost of medicines and of medical services increace mode of life of the population changes It is connected with distribution of risk factors (smoking, abusing alcohol), socially - caused diseases the level of population education increace Everybody wants to receive a full spectrum of medical services in comfortable conditions. some part of the population has low solvency sometime work of public health services is insufficient

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Basic problem of health care system In conditions of increasing costs on health care system and low expenditures every state should provide to everybody good quantity of medical care

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The increasing cost of healthcare products and services has become a great concern for patients, insurers, politicians, the public healthcare professionals, HOW This increasing concern has prompted demand for use of economic evaluations of alternative healthcare outcomes. ?

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Pharmacoeconomics is an innovative method that aims to decrease health expenditures, meanwhile optimising healthcare results Rising health expenditures have led to the necessity of finding the optimal therapy at the lowest price.

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• 1977 application of economics for pharmacy services began. • 1986 first time pharmacoeconomics appeared in literature focusing on products. • In 1999 drug trend report showed an increase in the double digits in pharmaceutical expenses from 1995-1999 (ring the bell). History

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Pharmacoeconomics emerged in the late 1980s as an independent entity among the varied specialised economic methods. Over the past 20 years, pharmacoeconomics has become more important due to an increased emphasis on efficient drug therapies for disease, which increase health costs, etc.

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In the present climate of rising health care costs, the most commonly asked question by the planners, providers, players and recipients of health care services is: Are the monies spent on health care programs justiefiable by theair outcomes?

What benefit new drug has?:

What benefit new drug has? New drug Old drug BENEFIT BENEFIT New drug Old drug * * * Cost ( drugs , hospitalization , diagnostics …)

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Pharmacoeconomics is a specific form of health economics that is restricted to pharmaceutical products. Pharmacoeconomics can be described as a social science concerned with the impact of pharmaceutical products and services on individuals, health systems and society, as well as the description and analysis of the costs. One of the primary goals of pharmacoeconomics is to determine which healthcare alternatives provide the best healthcare outcome per dollar spent.

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Pharmacoeconomics aims to improve the allocation of resources for pharmaceutical products and services. Numerous pharmacoeconomic methods are utilised to determine the least expensive treatment with the best treatment outcome. Healthcare policies worldwide are focused on increasing efficiency at a lower cost without reducing either the quality of healthcare or access to it.

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Pharmacoeconomics involves the utilisation of two major methodologies for health economics analysis: cost analysis and cost outcomes. The three broad categories of consequences (outcomes) are clinical humanistic outcomes economic

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Blood pressure in hypertension Number of recurrences Number of disease free patients clinical outcomes Mortality Morbidity Specific clinical indicators:

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humanistic outcomes Quality of life Patient's satisfaction Patient's preference

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economic outcomes COSTS Indirect Direct Intangible

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This escalation in healthcare spending is due to increased life expectancy, increased technology, increased expectations, increased standards of living and an increased demand in healthcare quality and services. Healthcare resources are not easily accessible and affordable to many patients, therefore pharmacoeconomic evaluations play an important role in the allocation of these resources. Pharmacoeconomics is a modern applied science, it is methodology of an economic evaluation of medical and non medical treatment ’ s quality on the basis of the interconnected clinical-economic analysis.

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The presence of both costs and outcomes distinguishes a proper pharmacoeconomic analysis from traditional cost-containment strategies or drug use evaluations. The main purpose of a pharmacoeconomic evaluation is to compare the costs and consequences of therapeutic alternatives.

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=10x10/8= 12,5$/1pat. pat. without fever + + Aspirin Panadol = = Number of disease free patients - 6 Number of disease free patients - 8 Number of ill patients - 10 Number of ill patients - 10 СЕ R 1 = cost/Ef СЕ R 2 = cost/Ef cost = 6 $ cost = 10 $ What alternative is the more cost effective? =6x10/6= 10$/ 1 pat. without fever

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The sources of information about subject are: report (summary) of clinical trials; report (summary) of pharmacoepidemiological trials. Pharmacoeconomics includes ideas and methods from such branches of science: statistics, clinical epidemiology, economics, decision analysis and psychometrics, etc. The main subject of pharmacoeconomics is evaluation of therapeutic intervantions according to its cost-effecteveness ratio (CER)

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integrated character (it allows to use achievements from branches of science effectively applied value (it solves problems of health care) economic value (it allows to use the limited resources of public health services and money resources of patients rationally); social value (it is defined by specificity of objects of research: therapeutic effect, physical health and social - psychological adaptation in a society). Distinctive features of Pharmacoeconomics are:

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Health technology (medical interventions) can be defined broadly as: Any intervention that may be used to promote health, to prevent, diagnose or treat disease or for rehabilitation or long-term care. This includes the pharmaceuticals, devices, procedures and organizational systems used in health care.

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Health technology assessment (HTA) : the systematic evaluation of properties, effects, and/or impacts of health care technology. Its main purpose is to inform technology-related policymaking in health care. HTA is conducted by interdisciplinary groups using explicit analytical frameworks drawing from a variety of methods.

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Parameters of pharmacoeconomic evaluation of health technologies Efficacy (ideal effectiveness) Clinical effectiveness (real effectiveness) Safety Utility Compliance Benefit Costs

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It is determined in parameters of decrease mortality, morbidity, number of recurrences, number of disease free patients. Efficacy (ideal effectiveness) The result of treatment in ideal and controlled circumstances (in clinical randomize trials). Efficacy is derterminided in somatic parameters, that is changes of biological parameters of health. For example, change of a cholesterol blood level). Clinical effectiveness (real effectiveness) The result of a treatment in usual or real world circumstances or the treatment outcomes in usual care conditions. Parameters of pharmacoeconomic evaluation of medical interventions

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Safety – frequency and severe of adverse effects of a medical product or a method of treatment Utility – of pharmacotherapy, it determines on the basis of an estimation of quality of patient's life ( quality of life, patient's satisfaction, patient's preferens). Parameters of pharmacoeconomic evaluation of medical interventions During Pharmacoeconomic evaluation of treatment are necessary for taking into account this cost for treatment of adverse reactions.

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Parameters of pharmacoeconomic evaluation of medical interventions Compliance – adherence of patient to use of this medicine, but not another according to doctor ’s recommendations . Benefit – outcomes of treatment (in monetary value). Cost are defined as the input resources utilized by the therapeutic strategy and/or intervention

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Interrelation pharmacoeconomics with pharmaceutical, medical and economic disciplines Organisation and Economics Of Pharmacy Marketing Pharmacology Economics Clinical Pharmacology pharmacoeconomics Health care system Insures medicine Pharmaceutical aspects Of Insures medicine

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“Economic depression cannot be cured by legislative action or executive pronouncement. Economic wounds must be healed by the action of the cells of the economic body - the producers and consumers themselves.” Herbert Hoover

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Thanks for attention

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