Updating skills: pharmacoeconomics as continuing education

With the increased numbers of pharmacoeconomic trials being conducted and reported, the practicing pharmacist will need to apply this information in formulary decision making. The review provides suggestions about readily available pharmacoeconomic continuing education opportunities for the practitioner. Examples of printed materials, home study programs, and meeting presentations are discussed. A combination of approaches is recommended.     

Strategic planning for applied pharmacoeconomics programs

Escalating costs are changing the infrastructure in which health care is provided. Managed care programs are financing an ever-increasing share; rationing has already become reality in at least one state; and the federal government is once again examining the concept of a national health care plan. The primary goal of each of these initiatives is to control cost: the increasing cost of providing drug therapy is a major target. Increasing demands for shrinking resources will demand demonstration of value for money spent. Pharmacoeconomics provides a mechanism to establish the value of drug therapy. Using the strategic planning process, the Division of Pharmacy at M.D. Anderson Cancer Center and the Department of Pharmacy Services at Oregon Health Sciences University Hospital and Clinics have developed pharmacoeconomics programs to provide the focus for ensuring that every dollar spent on drug therapy and pharmaceutical services buys the best outcomes. These two case studies illustrate the processes for developing an applied pharmacoeconomics program and the activities such a program should embrace.     

药物经济学评价Markov模型实例解析

目的: 本文旨在对已建立的Markov模型进行解析,为中国胃癌治疗方案的药物经济学研究奠定基础。方法: 深入分析Markov模型建立的理由和方法。结果: 胃癌治疗后的自然转归符合Markov基本原理,可划分为三种互不相容的生存状态,合理假设可简化Markov模型,转移概率是Markov模型是否正确的关键。结论: 对中国胃癌患者两种治疗方案进行药物经济学评价,可采用划分3种互不相容健康状态,使用TreeAge软件创建Markov模型,利用公开发表的大型Ⅲ期临床试验结果,结合WHO生命表数据确定转移概率,以此创建切实可行的Markov模型。     

Outcome assessment: functional status measures as therapeutic endpoints for heart failure

The role of measures of patients' functional status during chronic heart failure is to bridge the outcome information gap between physiologic assessments and the goal of medical care, which is to prolong the patient's life with minimal disability due to the syndrome and subsequent health care. The methods of rigorously developing and applying patient questionnaires as outcome measures will be unfamiliar to many health care providers. Many health care providers trained with different perspectives probably have an incredulous view of patient evaluations. What have we accomplished, though, if patients cannot perceive a net benefit from our services? In the final analysis, the patients' outcome assessments, collected in a systematic and unbiased manner, rather than the proxy measures used by health care providers, are the bottom line.     

The dynamic field of pharmacoeconomics

Maarten Jacobus Postma is Professor in Pharmacoeconomics at the University of Groningen (The Netherlands), Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics. Next to teaching, he coordinates the research of a group of ten PhD students, one postdoctoral researcher and five (annually changing) MSc students. The majority of this research is related to the cost–effectiveness of vaccinations and methodological issues surrounding this (dynamic modeling and discounting), besides other health–economic and pharmacoeconomic topics. He is President of the section Public Health Economics of the European Public Health Association (EUPHA). Furthermore, he is on the Scientific Advisory Board of two worldwide consultancy firms. Finally, he advises the Dutch government on the reimbursement of new drugs and vaccines in two high-impact committees (Health Council and Committee Pharmaceutical Help). Here, Professor Postma speaks to Expert Review of Clinical Pharmacology about the dynamic field of pharmacoeconomics.     

The pharmacoeconomics of HIV disease

Human immunodeficiency virus (HIV) infection is a major public health problem in all parts of the world. For the United States, federal spending on HIV disease for 1982 to 1989 was $US5.5 billion. Projections indicate that AIDS spending may reach 1.6% of total health expenditures in 1992, while the indirect costs of HIV infection may be 5 times as great as the direct costs. In the developing world, the cost per person with HIV infection may be 0.8- to 9-fold greater than the per capita gross national product (GNP). Pharmacoeconomic analysis has been used to assess 2 important therapeutic options in caring for HIV patients: zidovudine therapy for asymptomatic illness, and prophylaxis for Pneumocystis carinii pneumonia (PCP). The cost-effectiveness ratio for zidovudine therapy, $US6553 to $US70 526 per year of life saved, compares favourably with ratios for other medical therapies. Prophylaxis against Pneumocystis carinii pneumonia has been shown to be most efficient using oral dapsone or cotrimoxazole (trimethoprim-sulfamethoxazole). Pharmacological therapy for HIV is costly, however, and may limit the access to new therapies for patients in the developing world. Concurrent economic assessment of therapies during phase III trials may serve as an essential part of the research that will advance international efforts to combat this disease.     

The pharmacoeconomics of high-cost biotechnology products

Biotechnology products have created therapy options in areas that have been historically limited. These improvements in patient care have resulted in a reappraisal of the emphasis placed on product acquisition costs and a movement toward evaluating the impact of the product on the entire health care system. Strategic planning for biotechnology products allows pharmacists to partner with the medical staff and financial/administrative representatives of the institution to measure clinical outcomes, estimate cost and revenue impact, document utilization, and promote cost-effective use of these new therapies to generate the maximum benefit for dollars expended.     

Overview of the pharmacoeconomics of pharmacogenetics

Pharmacoeconomics and pharmacogenetics are two fields converging together as it is increasingly recognized that genetic markers predicting efficacy and toxicity to drugs can cost-effectively improve patient care. While pharmacogenetics aims at identifying genetic markers underlying the response to drugs, pharmacoeconomics aims at delivering healthcare cost-effectively. Several studies have investigated the potential cost-effectiveness of pharmacogenetic-based approaches. Recent evidences include screening for thiopurine methyltransferase gene polymorphisms to prevent azathioprine-induced myelosuppression, or screening for human leukocyte antigen (HLA)B5701 to prevent hypersensitivity reactions to abacavir therapy. Furthermore, examples suggesting a cost-effectiveness of markers predicting drug efficacy include screening the angiotensin-converting enzyme gene polymorphisms for statins therapy, the alpha-adducin gene variant for diuretic therapy and the assessment of human epidermal growth factor receptor (HER2) expression for trastuzumab therapy. However, thus far, all these pharmacoeconomic analyses are exploratory and validations in prospective randomized clinical trials are warranted.     

Overview of the lenograstim pharmacoeconomics programme

Lenograstim is a recombinant colony-stimulating factor that has been shown to be a useful adjunctive agent in cancer chemotherapy. Clinical trials have demonstrated the efficacy of lenograstim in correcting chemotherapy-induced neutropenia and associated complications in inflammatory breast cancer and non-Hodgkin's lymphoma, and in facilitating dose intensification of chemotherapy in small cell lung cancer. To meet increasing demands for economic data on new drug entities, a lenograstim pharmacoeconomics programme was established. This programme involved prospective economic evaluations of lenograstim that were undertaken as part of phase III randomised clinical trials by a combined German/Italian health-economics team (inflammatory breast cancer), a French team (non-Hodgkin's lymphoma), and a team from the UK (small cell lung cancer).     

量效关系在药物经济学中的应用

目的：寻找药物经济学研究新的思路和方法,揭示药物治疗学中的经济规律,为提倡药品理性消费提供理论依据。方法：将数学药理学和药物经济学的研究方法结合起来,推导成本-效果的量效关系式,并建立成本-有效曲线、成本-毒效曲线以及成本-实效曲线。将社会用药消费范围定义为弱效用药、增效用药、有效用药、减效用药及有害用药几个区段。结果：随着购买药品费用的不断增加,药品的有效率逐渐达到最大值不再变化,不良反应发生率也逐渐增加,使药品的实效价值呈现先升后降的变化。结论：药物疗效与药物治疗成本之间存在着定量关系,为了节省医疗成本,控制药费增长,促进合理用药,必须提倡在增效用药和有效用药的范围内用药;在药物品种的选择上,要考虑药物的效果/成本比,选择高效的品种,同时也要衡量消费者的经济承受能力;应该提高对基本药物的使用。     

基础胰岛素的药物经济学研究概述

国际糖尿病联盟(IDF)的数据显示,2010年中国糖尿病患病率已达4.5%.仅次于印度[1].中华医学会糖尿病学分会在中国14个省市进行的糖尿病和代谢综合征患病率调查结果显示,在20岁以上的人口中,糖尿病的年龄标化患病率为9.7%,而糖尿病前期的年龄标化患病率更达到15.5%[2].     

运用药物经济学研究成果指导临床合理用药

“安全、有效、经济、适当”是临床合理用药遵循的四大原则，而“经济”则是目前临床用药中更显突出和亟待解决的问题。药物经济学研究的兴起和发展，使该问题的解决成为可能。充分了解并善于运用其研究成果指导临床合理用药，则成为临床药学工作的重要内容。     

我国药物经济学评价常见问题及其改进建议

随着来自医疗机构的药学工作者的药物经济学评价方面的文献日益增多,如何通过提升其评价的科学性与正确性来促进我国药物经济学发展越来越必要和重要.文中总结、分析了我国医疗机构药学工作者在药物经济学评价文献中存在的主要问题,并针对这些问题提出改进措施及建议,以期在评价准则和相关政策要求缺失的现实情况下,通过提高自发性的药物经济学评价水平,来推动我国药物经济学健康、快速发展.     

Assessing antibacterial pharmacoeconomics in the intensive care unit

Intensive care units (ICUs) represent areas of high use of antibacterials and other pharmacy goods and services. Many institutions view their ICUs as a target for drug-use surveillance and cost-containment programmes. Economic assessment of antibacterial interventions in the ICU should include all direct costs and patient outcomes. Nonetheless, many of these institutions focus their efforts at reducing antibacterial costs without considering the consequences of these actions. It is possible that devoting more resources to antibacterials can have an overall positive economic impact if more appropriate antibacterial use reduces length of stay, decreases bacterial resistance or lowers frequency of adverse complications. Two consequences of antibacterial use which can result in substantial economic burdens to institutions are drug-induced complications (toxicities and adverse events) and the development of antibacterial-resistant organisms. These events are logical targets for performing pharmacoeconomic studies to evaluate appropriate and inappropriate antibacterial use. Either of these problems can increase length of stay, which is the single most important variable influencing the overall cost of patient care. The primary goal of patient care is to hasten patients' clinical improvement. This will result in decreased antibacterial acquisition costs, decreased lengths of ICU and hospital stays, and ultimately decreased consumption of hospital resources. These can be accomplished by using strategies to guide antibacterial use in order to reduce failures, adverse events, toxicity and antimicrobial resistance.