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Introduction
Spending on drugs is a major target for savings in health
care costs for governments around the world. Such a focus
results from the size of the drug bill, the highly visible
nature of drug utilization and the perception that the drug
budget is currently not being used to best advantage. In
addition the drugs bill is an area in which it is perceived
that savings can be made without detriment to patients [1]
and without having to address sensitive issues relating to
staff redundancy. The total cost of the drug bill in 1994 was
3844 million which represented a cost of over 65 per
capita and an average of 8.9 prescriptions were consumed
per head of population [2]. Government attempts to contain
the drug bill include increased patient copayments, encouragement of formularies, and the utilization of indicative or
real drug budgets. The use of cost limited drug budgets to
constrain the overall drugs bill has experienced some success
in the UK [3].
The impact of placing severe constraints on the drugs bill
needs to be evaluated to ensure that it does not lead to
significant increased costs elsewhere in the health care
system (e.g. increased inpatient episodes or diagnostic tests)
or lead to a significant reduction in the level of benefits to
patients. The focus of concern to decision makers, health
care professionals and the public should be the value derived
from drug therapy, rather than simply the level of the drugs
bill. This wider focus requires a comparison of benefits
derived and costs incurred [1, 4]. It is not after all the
function of a health service to minimise costs but rather to
use its available resources to achieve the greatest health
gain for its population. By these criteria, increased spending
on drugs which leads to a reduction in the need for
hospitalisation or economises on the use of some other
expensive resource can represent a cost-effective shift in
resource utilization. The important issue concerns the
optimum manner of investing health care resources to
generate health gain and for this reason an increase in
expenditure on drugs may be a highly efficient use of scarce
health care resources. Such a comparison of the marginal
productivity (additional benefits derived from the application of additional resources) from different methods of
using resources is difficult but essential for a health service
determined to maximise patient benefit. Such assessments
are essential, not to reduce costs, but rather to identify the
benefits of alternative uses of resources in order to identify
the structure of health care that best meets the needs
of patients.
Pharmacoeconomics is a branch of health economics
which particularly focuses upon the costs and benefits of
drug therapy. A knowledge of pharmacoeconomics is
therefore vital for clinical pharmacologists who are involved
Correspondence: Professor T. Walley, Department of Pharmacology and Therapeutics,
University of Liverpool, Liverpool, UK
Table 1
Inputs (costs)
E
Medical interventions
E
Outcomes (beliefs)
Perspective
The cost-effectiveness of any health service intervention in
large part depends upon from whose point of view the study
is conducted. A range of potential perspectives can be adopted
from the most limited (impact of changes on a single drug
budget) to the societal where all indirect costs are studied as
well. Given that the aim of economic analysis is to make the
best use of all of societys resources, the societal perspective
is considered the most appropriate, but a health care manager
with a limited budget might be tempted to place increased
emphasis upon costs that are imposed upon his area. A study
of migraine from the perspective of the health service alone
would be likely to find that the use of sumatriptan in migraine
(a very high cost drug in an area which previously cost the
health service very little) was highly undesirable. In contrast
a study taking a societal perspective, that incorporates all of
the additional costs imposed upon the migraine sufferer,
might come to the opposite conclusion [29].
346
References
1 Walley T, Davey P. Pharmacoeconomics: a challenge for
clinical pharmacologists. Br J Clin Pharmacol 1995; 40:
199202.
2 O.H.E. Compendium of Health Statistics. 9th Edition, 1995.
Office of Health Economics, London.
3 Wilson R, Walley T. Prescribing costs in general practice
fundholding. Lancet 1995; 346: 17101711.
4 Walley T. Drugs, money and society. Br J Clin Pharmacol
1995; 39: 343345.
5 Drummond MF. Economic evaluation of pharmaceuticals:
marketing or science? PharmacoEconomics 1992; 1: 813.
6 Drummond, MF, Stoddart, GL, Torrance, GW. Methods for
the economic evaluation of health care programmes. Oxford, Oxford
University Press 1987.
7 Robinson R. Economic evaluation and health care: what does
it mean? Br Med J 1993; 307: 670673.
8 Robinson R. Economic evaluation and health care: costs and
cost-minimisation analysis. Br Med J. 1993; 307: 726728.
9 Robinson R. Economic evaluation and health care: cost
effectiveness analysis. Br Med J 1993; 307: 793795.
10 Robinson R. Economic evaluation and health care: costutility analysis. Br Med J 1993; 307: 859862.
11 Robinson R. Economic evaluation and health care: costbenefit analysis. Br Med J 1993; 307: 924926.
12 Robinson R. Economic evaluation and health care: the policy
context. Br Med J 1993; 307: 994996.
13 Finkler SA. The distinction between cost and charges. Ann Int
Med 1982; 96: 102109.
14 Chaput de Saintonge DM, Kirwan JR, Evans SJW, Crane
GJ. How can we design trials to detect clinically important
changes in disease severity? Br J Clin Pharmacol 1988; 26:
355362.
15 Torrance GW. Utility approach to measuring health-related
quality of life. J Chronic Dis 1987; 40: 593600.
16 Katz S. The science of quality of life. J Chronic Dis 1987; 40:
459463.
17 Spitzer WO. State of science 1986: quality of life and
functional status as target variables for research. J Chronic Dis
1987; 40: 465471.
18 Fitzpatrick R, Fletcher A, Gore S, Jones D, Spiegelhalter,
Cox D. Quality of life measures in health care. I: Applications
and issues in assessment. Br Med J 1992; 305: 10741077.
19 Quality of life measures in health care. II: Design, analysis,
and interpretation. Br Med J 1992; 305: 11451148.
20 Spiegelhalter DJ, Gore SM, Fitzpatrick R, Fletcher AE, Jones
DR, Cox DR. Quality of life measures in health care. III:
resource allocation. Br Med J 1992; 305: 12051209.
21 Williams A. Economics of coronary artery bypass grafting. Br
Med J 1985; 291: 326329.
22 Calman KC. Definitions and dimensions of quality of life. In
The quality of life of cancer patients. Raven Press. New York.
1987.
23 Torrance GW, Feeney D. Utilities and quality-adjusted life
years. Intl J of Technology Assessment in Health Care. 1989; 5:
559575.
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