Pharmacoeconomics and Health Outcomes

Decision Analysis Problem

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 Pharmacoeconomics and Health Outcomes
Group Exercise
Decision Analysis
NOTE: Please write ALL your final answers in this table, it will be easier to grade. Thanks!

Question
Write answer here
Number:

1. What is the average (or ‘expected’) cost per patient treated with Fentanyl? $540.50

2. What is the average (or ‘expected’) cost per patient treated with Piroxicam? $504.00

3. What are the average hospital days per patient treated with Fentanyl? 0.280 days

4. What are the average hospital days per patient treated with Piroxicam? 0.200 days

This is one of those unusual situations, where the choice of therapy is OBVIOUS, but
yields an incremental cost-effectiveness ratio (ICER) hich is numerically positive. This is
because the denominator is days in the hospital and this LARGER number is a POORER
5. outcome.

The incremental cost effectiveness ratio (ICER) is $456.25 per patient day which is saved
by using piroxicam over fentanyl
 The “2-Much Rum” Outpatient Clinic in Boston is evaluating two drugs for pain. Given
the clinic’s main patient population (i.e. college students with green curly hair and with acute
alcohol poisoning), only two drugs are being considered: fentanyl and piroxicam. We make the
following assumptions: both drugs are equally effective when dosed correctly; and the average
length of treatment is 5 days – about the length of a Spring Break. (Ignore any other clinical or
toxicity concerns you may have. Use only the information presented in this case to solve this
problem.)
A 5 day supply of fentanyl costs the clinic $120. Among all the patients who take
fentanyl, 5% will immediately develop serious nausea and vomiting and will require
promethazine which costs an additional $10. Regardless of what happens immediately, after 5
days of treatment, some of the patients who have taken fentanyl have a 7% chance of
developing a severe respiratory depression. This reaction may occur with equal likelihood
regardless of whether the n/v reaction occurred. (it can happen to both groups!) If respiratory
depression does occur, it represents an additional cost of $6,000 because the patient is
hospitalized for 4 days.
A 5 day supply of piroxicam cost the clinic $50. Among all the patients who take
piroxicam, 40% will immediately develop nausea and vomiting which also costs an additional
$10 to treat with promethazine. In addition, after 5 days, there is subsequently a 10% chance
that any piroxicam patients will develop a severe GI bleed which will take $4,500 to resolve
surgically, requiring 2 days in the hospital. The GI reaction may occur with equal likelihood
regardless of whether the n/v reaction occurred. (it can happen to both groups!)
1. What is the average (or ‘expected’) cost per patient treated with Fentanyl? $540.50

2. What is the average (or ‘expected’) cost per patient treated with Piroxicam? $504.00

3. What are the average hospital days per patient treated with Fentanyl? 0.280 days

4. What are the average hospital days per patient treated with Piroxicam? 0.200 days

5. Compute an incremental cost-effectiveness ratio per hospital days; and describe in writing
what the number means

The incremental cost effectiveness ratio (ICER) is $456.25 per patient day which is saved by
using piroxicam over fentanyl