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By: midhunscaria (33 month(s) ago)

good presentation

By: tuanpham (35 month(s) ago)

It is really a brief insight of pharmaeconomic.

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PHARMACOECONOMICS Presented by K.SATYANARAYANA M.Pharm, Ist sem (INDUSTRIAL PHARMACY) St.Peter’s Institute of Pharmaceutical Sciences Vidyanagar , Hanamkonda.



Learning Objectives : 

Learning Objectives Describe basic PE principles and methods commonly used in hospital pharmacy practice Define “applied pharmacoeconomics” and it’s role in pharmacy today Discuss the application of PE to inform pharmacy decision-making Compare and contrast common strategies for applying PE to daily pharmacy practice Review an example of how PE can be applied to solve a “real-world” problem

PE Applications – Mission and Summary of Services : 

PE Applications – Mission and Summary of Services Mission - To provide pharmacoeconomics and outcomes research, education, and consulting services to assess the value of pharmaceutical products and services in today’s healthcare systems. Summary of Services: Research services customized PE and OR studies site or population-specific economic models partnerships with HC organizations Educational services PE lectures and workshops PE educational materials Consulting services protocol design and strategic PE plans

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BASICS of Pharmacoeconomics

Basic PE Definitions : 

Basic PE Definitions Pharmacoeconomics: The description and analysis of the costs and consequences of pharmaceutical products and services and their impact on individuals, health care systems and society. Pharmaceutical care: The responsible provision of drug therapy for the purposes of achieving definite outcomes. Outcomes research: Broadly defined as studies that attempt to identify, measure and evaluate the end result of health care services in general.

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outcomes research pharmaco- economics pharmaceutical care Relationship between Outcomes, Pharmacoeconomics and Pharmaceutical Care

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Evolution of Pharmacoeconomics 1960’s 1970’s 1980’s 1990’s 2000 PK helps pharmacy evolve from distributive to clinical discipline Drug decisions based on safety, efficacy Cost containment strategies emerge Inclusion of economic outcomes into drug decisions Misuse of PE terminology AHCPR created in 1989 to conduct outcomes research PE components commonly included in Phase III RCT’s Guidelines for conduct and reporting of PE studies widespread Improved quality/rigor of published PE studies “Applied pharmacoeconomics” emerges CBA and CEA introduced into pharmacy literature 1979 first PE research article published PE has widespread application by clinicians and administrators Pharmaceutical manufacturers collaborate with MCO’s to provide provider-specific outcomes data

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PHARMACOECONOMIC METHODS Economic Humanistic Cost consequence Cost benefit Cost effectiveness Cost minimization Cost utility Quality of life Patient preferences Patient satisfaction

Summary of pharmacoeconomics methodologies : 

Summary of pharmacoeconomics methodologies Method description application COI *estimates the cost of disease *use to provide base line to compare on a defined population prevention/treatement options against. CMA *finds the least expensive cost use when benefits are the same. alternative CBA *measure benefit in monetory units *can compare progras with different and computers a net gain objectives. CEA *compares alternatives with therapeutics * can compare drugs/ programs that effects measured in physical units; differ in clinical out comes & use same computes a C/E ratio. Unit of benefit.

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CUA *measure therapeutic cosequences in *use to compare drugs/programs utility units rather than physical units that are life extending with serious effects or those producing reductions morbidity. CCA *measures multiple costs &out comes * examine whether the use of drugs without aggregatig the two into a produces an out come that decreases CE/CB ratio. Cost& offsets the price cost of the new therapy.

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Applied Pharmacoeconomics

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Applied Pharmacoeconomics… applications theory principles methods definitions

“Applied Pharmacoeconomics” : 

“Applied Pharmacoeconomics” Defined as : “Putting pharmacoeconomic principles, methods and theories into practice, to quantify the “value” of pharmacy products and pharmaceutical care services utilized in “real-world” environments”

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WHERE Pharmacoeconomics is Applied in the Real World

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Primary PE Applications Drug Therapy Evaluations Justify Pharmaceutical Care Services

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clinical humanistic economic Components of Clinical Decision-Making

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Specific Decisions for PE Applications Clinical Decisions Formulary Management Drug Use Guidelines Disease Management Resource Allocation MICRO MACRO Justification of Pharmacy Services

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Potential Hurdles for Application of PE to Drug Decision-Making Lack of “PE sophistication” by target audience (e.g. hospital administrators, MC pharmacy directors) Lack of “PE sophistication” by pharmacy practitioners who are generating and/or interpreting PE data Lack of organizational resources (time and $$) Component vs. system management approach Budget responsibilities

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HOW Pharmacoeconomics is Applied in the Real World

Strategies for Putting Theory into Practice : 

Strategies for Putting Theory into Practice Strategy 1: Interpret, critique, and use results from studies published in the literature Strategy 2: Utilize economic modeling Strategy 3: Conduct a local observational PE evaluation

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(Potential Impact of Decision on Cost And Quality) Compare acquisition costs Perform economic modeling Conduct retrospective study Conduct prospective study Review PE literature, conduct sensitivity analysis None Mild Moderate Extreme (Application Strategy) Scale for Selecting a PE Application Strategy

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Number of Studies Number of Published Cost Studies, by Year

Strategy 1: Use the Literature : 

Strategy 1: Use the Literature ADVANTAGES Data often plentiful Quick Inexpensive Subject to peer-review Variety of results can be examined Results from RCT DISADVANTAGES Results from RCT (costs may be protocol driven) External validity Placebo-controlled Misuse of PE terms Variations in quality of studies published

Strategy 2: Use Economic Modeling : 

Strategy 2: Use Economic Modeling ADVANTAGES Inexpensive Quick Yields organization-specific results Bridges efficacy to effectiveness Data collection is unobtrusive DISADVANTAGES Results dependent on assumptions Potential for researcher bias Controversial Reluctance of decision-makers to accept results May require a meta-analysis of the literature

Strategy 3: Conduct a Local Observational Study : 

Strategy 3: Conduct a Local Observational Study ADVANTAGES Flexible Yields provider-specific data Reflects “usual care” or effectiveness Usually offer comparative data Data from multiple sources can be used Are less expensive than RCT DISADVANTAGES Expensive (time and $) Difficult to control and randomize Potential for patient selection bias Small sample size May be difficult to generalize results to other patient populations and providers

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Examples: Applied Pharmacoeconomics in the “Real-World”

Targets for Local PE Evaluations : 

Targets for Local PE Evaluations Biotechnology agents New expensive agents Newly marketed agents Controversial agents New and existing clinical pharmacy services

Example One: Drug Therapy Evaluation (literature review) : 

Example One: Drug Therapy Evaluation (literature review) A literature review of t-PA vs. streptokinase for AMI was conducted to assess to assist in formulary management A variety of studies were critically evaluated and interpreted using 11 basic criteria These data were input into an economic model (using decision analysis) and customized to better reflect “real world” care at a specific organization Results lead to acceptance of organizational policy and formulary management decision favoring the use of t-PA in the organization

Criteria for Evaluating the Quality of a PE Study : 

Criteria for Evaluating the Quality of a PE Study Study objective Study perspective Study method (type of analysis) Study design Treatment interventions (comparators) Costs and consequences (outcomes) Study results Discounting (adjusting for differential timing) Sensitivity analysis Study conclusions Sponsorship

Example Two: Drug Therapy Evaluation (conduct local study) : 

Example Two: Drug Therapy Evaluation (conduct local study) A local CEA of stratified doses of ondansetron for CIE was conducted from a provider’s perspective, using a 14-step process Demographic, clinical, economic and humanistic outcomes data were collected Stratified dosing regimens were cost-effective, yielding equivalent clinical and humanistic outcomes Results lead to acceptance of organizational policy and dosing guidelines, realizing an annual cost-savings >$300,000

Process for Conducting a Local PE Evaluation : 

Process for Conducting a Local PE Evaluation Designed specifically for hospital pharmacy applications Incorporates steps of decision analysis Process can be used to guide PE evaluations to assess the “value” of pharmacy products and services

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Process for Conducting a Local PE Evaluation 1. Define the PE problem 2. Create a cross-functional team 3. Determine the study perspective(s) 4. Determine the comparators and outcomes 5. Select the appropriate PE method 6. Identify necessary resources and data sources 7. Place a monetary value on the outcomes

Process for Conducting a Local PE Evaluation (continued) : 

Process for Conducting a Local PE Evaluation (continued) 8. Establish probabilities of outcomes 9. Use decision analysis (when appropriate) 10. Perform discounting and/or sensitivity analysis 11. Present the results to appropriate groups 12. Develop a policy or intervention 13. Implement and educate 14. Document “value” through follow-up

Conclusions : 

Conclusions Applied PE has been the “missing link” in pharmacy PE principles and methods can be successfully applied in the “real world” to enhance decision-making PE can be applied to any therapeutic area, using a variety of application strategies Application of PE to the “real world” is a new dimension, challenge and opportunity for hospital pharmacy


REFERENCES: Bootman JL, The Impact of Health Care Reform, J. Pharm. Rep., 1993; 23(12): 4- 6. Mackeigan L, Larson L, Draugalis J, Bootman JL, Burns L. Time Preference for Health Gains Versus Health Losses, Pharmacoeconomics 1993; 3(5): 374-386. Kortt MA, Bootman JL, The Economics of Benign Prostatic Hyperplasia Treatment: A Literature Review, Clinical Therapeutics, 1996; 18 (6): 1227-1241 Johnson J, Bootman JL, Drug Related Morbidity and Mortality and the Economic Impact of Pharmaceutical Care, Am. J. Health Systems Pharmacy, 1997: 54 (Mar 1): 554-558 Harrison DL, Bootman JL, Strategic Planning by Institutional Pharmacy Administrators, Journal of Pharmaceutical Marketing and Management 1994: 8 (2): 73-96.

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