Pharmacoeconomics

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Pharmacoeconomics refers to the scientific discipline that compares the value of one pharmaceutical drug or drug therapy to another. [1] [2] It is a sub-discipline of health economics. A pharmacoeconomic study evaluates the cost (expressed in monetary terms) and effects (expressed in terms of monetary value, efficacy or enhanced quality of life) of a pharmaceutical product. Pharmacoeconomic studies serve to guide optimal healthcare resource allocation, in a standardized and scientifically grounded manner.

Contents

Economic evaluation

Pharmacoeconomics centers on the economic evaluation of pharmaceuticals, and can use cost-minimization analysis, cost-benefit analysis, cost-effectiveness analysis or cost-utility analysis. Quality-adjusted life years have become the dominant outcome of interest in pharmacoeconomic evaluations, and many studies employ a cost-per-QALY analysis. Economic evaluations are carried out alongside randomized controlled trials and using methods of decision-analytic modeling. Pharmacoeconomics is a useful method of economic evaluation of various treatment options. As more expensive drugs are being developed and licensed it has become imperative especially in context of developing countries where resources are scarce to apply the principles of pharmacoeconomics for various drugs and treatment options so that maximum improvement in quality of life can be achieved in minimum cost. [3]

In policy

In 1993, Australia became the first nation to use pharmacoeconomic analysis as part of the process for deciding whether new drugs should be subsidized by the Federal Government. The Pharmaceutical Benefits Advisory Committee (PBAC) advises Federal Government ministers on whether new drugs should be placed on a list for of drugs that consumers can then purchase from pharmacies at a subsidized price. Since 1993, this approach to evaluating costs and benefits is used in Canada, Finland, New Zealand, Norway, Sweden, and the UK.

Impact of pharmaceutical innovations

In the past 30 years, major pharmaceutical innovations have improved condition-related outcomes for six serious medical conditions: ischemic heart disease, lung cancer, breast cancer, human immunodeficiency virus (HIV) infection, type 2 diabetes mellitus, and rheumatoid arthritis (RA). [4] Spending on new pharmaceuticals and R&D, although expensive, is considered to bring net benefits, as it decreases overall health care costs. A study of 30 countries estimated that 73% of the increase in life expectancy in recent decades is due to new pharmaceuticals alone. Another study found that new drugs have reduced hospital usage by 25% per decade by replacing more expensive forms of care like surgery. It has been estimated that the cost per additional life-year gained thanks to pharmaceutical innovation was US$2,730, compared with US$61,000 for dialysis, a commonly used benchmark. [5]

See also

Related Research Articles

<span class="mw-page-title-main">Pharmacology</span> Branch of biology concerning drugs

Pharmacology is a science of medical drug and medication, including a substance's origin, composition, pharmacokinetics, therapeutic use, and toxicology. More specifically, it is the study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function. If substances have medicinal properties, they are considered pharmaceuticals.

Cost-effectiveness analysis (CEA) is a form of economic analysis that compares the relative costs and outcomes (effects) of different courses of action. Cost-effectiveness analysis is distinct from cost–benefit analysis, which assigns a monetary value to the measure of effect. Cost-effectiveness analysis is often used in the field of health services, where it may be inappropriate to monetize health effect. Typically the CEA is expressed in terms of a ratio where the denominator is a gain in health from a measure and the numerator is the cost associated with the health gain. The most commonly used outcome measure is quality-adjusted life years (QALY).

The incremental cost-effectiveness ratio (ICER) is a statistic used in cost-effectiveness analysis to summarise the cost-effectiveness of a health care intervention. It is defined by the difference in cost between two possible interventions, divided by the difference in their effect. It represents the average incremental cost associated with 1 additional unit of the measure of effect. The ICER can be estimated as:

<span class="mw-page-title-main">Health economics</span> Branch of economics

Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare. Health economics is important in determining how to improve health outcomes and lifestyle patterns through interactions between individuals, healthcare providers and clinical settings. In broad terms, health economists study the functioning of healthcare systems and health-affecting behaviors such as smoking, diabetes, and obesity.

Cost–benefit analysis (CBA), sometimes also called benefit–cost analysis, is a systematic approach to estimating the strengths and weaknesses of alternatives. It is used to determine options which provide the best approach to achieving benefits while preserving savings in, for example, transactions, activities, and functional business requirements. A CBA may be used to compare completed or potential courses of action, and to estimate or evaluate the value against the cost of a decision, project, or policy. It is commonly used to evaluate business or policy decisions, commercial transactions, and project investments. For example, the U.S. Securities and Exchange Commission must conduct cost-benefit analyses before instituting regulations or deregulations.

An orphan drug is a pharmaceutical agent that is developed to treat certain rare medical conditions. An orphan drug would not be profitable to produce without government assistance, due to the small population of patients affected by the conditions. The conditions that orphan drugs are used to treat are referred to as orphan diseases. The assignment of orphan status to a disease and to drugs developed to treat it is a matter of public policy that depends on the legislation of the country.

<span class="mw-page-title-main">National Institute for Health and Care Excellence</span> Non-departmental public body of the Department of Health in the United Kingdom

The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body, in England, of the Department of Health and Social Care, that publishes guidelines in four areas:

Cost–utility analysis (CUA) is a form of economic analysis used to guide procurement decisions. The most common and well-known application of this analysis is in pharmacoeconomics, especially health technology assessment (HTA).

<span class="mw-page-title-main">Quality-adjusted life year</span> Measure of disease burden

The quality-adjusted life year (QALY) is a generic measure of disease burden, including both the quality and the quantity of life lived. It is used in economic evaluation to assess the value of medical interventions. One QALY equates to one year in perfect health. QALY scores range from 1 to 0 (dead). QALYs can be used to inform health insurance coverage determinations, treatment decisions, to evaluate programs, and to set priorities for future programs.

<span class="mw-page-title-main">Disability-adjusted life year</span> Measure of disease burden

The disability-adjusted life year (DALY) is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death. It was developed in the 1990s as a way of comparing the overall health and life expectancy of different countries.

Pharmaceutical policy is a branch of health policy that deals with the development, provision and use of medications within a health care system. It embraces drugs, biologics, vaccines and natural health products.

College of Pharmacy is part of the University of Arizona, a public university in Tucson, Arizona, United States. It is the only pharmacy school at a public Arizona university and one of four health professions colleges at the Arizona Health Sciences Center campus. The college is accredited by the Accreditation Council for Pharmacy Education.

Pharmacy in China involves the activities engaged in the preparation, standardization and dispensing of drugs, and its scope includes the cultivation of plants that are used as drugs, the synthesis of chemical compounds of medicinal value, and the analysis of medicinal agents. Pharmacists in China are responsible for the preparation of the dosage forms of drugs, such as tablets, capsules, and sterile solutions for injection. They compound physicians', dentists', and veterinarians' prescriptions for drugs. Pharmacological activities are also closely related to pharmacy in China.

Medication costs, also known as drug costs are a common health care cost for many people and health care systems. Prescription costs are the costs to the end consumer. Medication costs are influenced by multiple factors such as patents, stakeholder influence, and marketing expenses. A number of countries including Canada, parts of Europe, and Brazil use external reference pricing as a means to compare drug prices and to determine a base price for a particular medication. Other countries use pharmacoeconomics, which looks at the cost/benefit of a product in terms of quality of life, alternative treatments, and cost reduction or avoidance in other parts of the health care system. Structures like the UK's National Institute for Health and Clinical Excellence and to a lesser extent Canada's Common Drug Review evaluate products in this way.

<span class="mw-page-title-main">Health technology assessment</span> Field of policy analysis

Health technology assessment (HTA) is a multidisciplinary process that uses systematic and explicit methods to evaluate the properties and effects of a health technology. Health technology is conceived as any intervention at any point in its lifecycle. HTA aim is to inform "decision-making in order to promote an equitable, efficient, and high-quality health system".  It has other definitions including "a method of evidence synthesis that considers evidence regarding clinical effectiveness, safety, cost-effectiveness and, when broadly applied, includes social, ethical, and legal aspects of the use of health technologies. The precise balance of these inputs depends on the purpose of each individual HTA. A major use of HTAs is in informing reimbursement and coverage decisions by insurers and national health systems, in which case HTAs should include benefit-harm assessment and economic evaluation." And "a multidisciplinary process that summarises information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner. Its aim is to inform the formulation of safe, effective, health policies that are patient focused and seek to achieve best value. Despite its policy goals, HTA must always be firmly rooted in research and the scientific method".

Specialty drugs or specialty pharmaceuticals are a recent designation of pharmaceuticals classified as high-cost, high complexity and/or high touch. Specialty drugs are often biologics—"drugs derived from living cells" that are injectable or infused. They are used to treat complex or rare chronic conditions such as cancer, rheumatoid arthritis, hemophilia, H.I.V. psoriasis, inflammatory bowel disease and hepatitis C. In 1990 there were 10 specialty drugs on the market, around five years later nearly 30, by 2008 200, and by 2015 300.

The Institute for Clinical and Economic Review (ICER) is a Boston-based independent nonprofit organization that seeks to place a value on medical care by providing comprehensive clinical and cost-effectiveness analyses of treatments, tests, and procedures.

<span class="mw-page-title-main">Louis Preston Garrison</span> American health economist (born 1950)

Louis Preston Garrison Jr. is an American health economist who has made significant contributions to pharmacoeconomics, pharmacogenomics and personalized medicine, regulatory benefit-risk analysis, insurance, pricing, reimbursement and risk-sharing agreements. He also made numerous contributions on the economic evaluation of pharmaceuticals, diagnostics, devices, surgical procedures, and vaccines, particularly as related to organ transplantation, influenza, measles, obesity, and cancer. Garrison has published over a hundred manuscripts in peer-reviewed journals and contributed to several book chapters.

ISPOR—The Professional Society for Health Economics and Outcomes Research, better known as ISPOR, is a nonprofit global professional organization in health economics and outcomes research. It was founded in 1995 as an international multidisciplinary professional organization that advances the policy, science, and practice of pharmacoeconomics and outcomes research. The society's mission is to promote health economics and outcomes research to improve decision making for health globally.

Aslam Anis is a Bangladeshi-Canadian health economist whose primary areas of research involvement include health services research, measuring patient-reported outcomes, Canadian competition policy in the pharmaceutical industry, and the cost-effectiveness of treatments for HIV/AIDS, rheumatoid arthritis, and other conditions.

References

Citations

  1. Mueller, C; Shur, C.; O'Connell, J. (1997). "Prescription Drug Spending: The Impact of Age and Chronic Disease Status". American Journal of Public Health. 87 (10): 1626–29. doi:10.2105/ajph.87.10.1626. PMC   1381124 . PMID   9357343.
  2. Arnold, Renée J.G.; Ekins, Sean (2010). "Time for Cooperation in Health Economics among the Modelling Community". PharmacoEconomics. 28 (8): 609–613. doi:10.2165/11537580-000000000-00000. PMID   20513161. S2CID   23088517.
  3. Deepak Bhosle, Asif sayyed*, Shaikh Huzaif, Alimuddin Shaikh, Vasundhara Bhople, Ayman Ali Khan.PHARMACOECONOMICS IN INDIAN CONTEXT. International journal of current pharmceutical and clinical research vol 7 issue 1 -2017 11-14 http://ijcpcr.com/download.php?id=262&f=1482469439(ijcpcr).pdf
  4. Herring, William; Ciarametaro, Michael; Mauskopf, Josephine; Wamble, David; Sils, Brian; Dubois, Robert (2022-02-21). "What might have happened: the impact of interrupting entry of innovative drugs on disease outcomes in the United States". Expert Review of Pharmacoeconomics & Outcomes Research: 1–13. doi:10.1080/14737167.2022.2035219. ISSN   1473-7167.
  5. Post, Special to Financial (2020-02-05). "To save lives and money, Ottawa needs to make it more attractive for new drugs to come to Canada". Financial Post. Retrieved 2021-10-25.

Sources

  • Rascati, Karen (2013). Essentials of Pharmacoeconomics. Philadelphia, PA: Wolters/Kluwer – Lippincott Williams & Wilkins. ISBN   978-1-4511-7593-6.