Introduction to

Pharmacoeconomics

YUNITA
Fakultas Farmasi Universitas Airlangga
References

Principles of Pharmacoeconomics
3rd Edition
Bootman, Raymond and McGhan
Essentials of Economic Evaluation in
Healthcare
Rachel Elliott and Katherine Payne
The Relationship between Economics and
Epidemiology
Epidemiology Health
services Economics
research

Clinical
Epidemiology
Health
Economics
Outcomes
Research

Pharmaco-
epidemiology
What is Pharmacoeconomics

Research that identifies, measures and

compares the costs (resources consumed)
and consequences of pharmaceutical
products and services
(Bootman et al, 1989)

4
What is Pharmacoeconomics

Research that identifies, measures and

compares the costs (resources consumed)
and consequences of pharmaceutical
products and services
(Bootman et al, 1989)

Two Major Components

5
The Practice

Pharmacoeconomic guideline by government

Australia, Canada, UK
Nongovernmental guideline US
Most industrialized countries government is the
primary payer for healthcare services including
prescription drugs
Australia the first government to implement
pharmacoeconomic guidelines
Australian PBS regulates over 90% of outpatient
prescription dispensed in Australia
COST
Opportunity Cost

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Opportunity Cost

True economic cost is concerned with the

opportunity cost of that process or
intervention
Ideally opportunity cost is used
Factually unit cost is usually used
Opportunity cost the benefit that would be
derived from using a resource in its best
alternative use

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Opportunity Cost
Anda memiliki uang Rp 200.000.000,-
Anda diberikan 3 pilihan
1. Yang manakah yang anda pilih?
Liburan
Mobil
Disumbangkan untuk amal
2. Benefit apa yang anda identifikasi untuk masing-masing pilihan
tersebut?
Liburan tidak bekerja, waktu bersama keluarga
Mobil mobil anda saat ini tidak memuaskan
Amal anda yakin bahwa beramal akan membawa rejeki
3. Biaya (costs) apa yang anda identifikasi melekat pada pilihan
anda?
Bila anda memilih liburan, anda tidak mendapat benefit dari
membeli mobil dan beramal, begitu pula sebaliknya

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Opportunity Cost

In health services the decision should

involve a comparison between at least 2
alternatives
Ideal if maximum health gain in a defined
patient population were attained at the lowest
opportunity cost
Getting the most out of an intervention from a
defined budget

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Categories of Costs

Total Cost

Direct Cost Indirect Cost Intangible Cost

Direct Medical Direct Non-

Cost medical Cost

Fixed Cost Semifixed Cost Variable Cost

12
Categories of Costs
Direct medical costs:
Associated with the drug and the medical care acquisition costs,
preparation costs, physicians fees, administration of medication, cost of
treating an ADR
E.g. Pharmaceuticals, hospital costs

Direct non-medical cost:

Those relevant to providing the therapy, including transportation to
health care facilities
E.g. Home assistance, travel

Indirect costs:
Result from lost of productivity (time off work due to sick leave)

E.g. Lost work days, early retirement, reduced productivity at work

Intangible costs:
Associated with pain and suffering of disease

E.g. Quality of life

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Fixed, Semifixed and Variable Costs
Fixed cost
Those incurred whether patients are treated or not
2 major components: overhead and capital costs

Overheads: those incurred by the running of the service: lighting,

heating, cleaning costs
Capital costs: incurred when major capital assets such as
counselling rooms are built, or equipment is purchased
Variable cost
Cost incurred from patients treatment

Disposable equipments, drugs, blood products, investigations,

etc
Semifixed cost
Tend to increase only when there is a large increase in activity
Staffing costs

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Contoh Paper

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Question 1

Cost apa saja yang digunakan dalam

penelitian ini?

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Costs
Perspective
Perspective

The costs included depend on the

perspective of the evaluation
Perspective of the study should be stated
The point of view from which the study is
conducted:
Patients
Providers (e.g. hospitals)
Payer (e.g. governments/insurers/employers)
Employer
Society (societal perspective)
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Perspective

The ideal perspective = societal

Look at the costs from the viewpoint of society as
a whole
Direct, indirect and intangible costs
Mostly used = health care provider
perspective
Direct medical costs

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Perspective

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Question 2

Perspective apa yang digunakan dalam

penelitian tersebut?

22
Perspective

23
Perspective

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Perspective

What is missing??
How are cost valued?

Collecting Costs

Bottom Up
Top Down
(microcosting)

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How are cost valued?

Top Down
Use the total budget to produce average costs per patient
(+) quick, available through the accounting system
(-) assume that all patients have the same diagnosis,
severity of illness and treatment not sensitive to changes
in the treatment
Bottom Up
Measure resource use by individual patients
(+) able to detect treatment differences between patient
(-) time consuming, expensive, need to be collected
especially for the study

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Incremental costs and marginal costs

Incremental cost
the difference in overall cost between 2
alternatives
Marginal cost
the cost of carrying out one more intervention

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OUTCOME
Outcomes

Clinical outcome
The results of treatment with a drug (+/-)
Humanistic outcome
Look at therapy from patients points of view
How the patient feels, quality of life??
Economic outcome
Cost associated with a therapy
Outcomes

To assess the benefit of healthcare

-- Correct identification
Patient outcomes
-- Correct measurement

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Main Categories of Outcome Measured

1. Effectiveness
2. Quality of Life
3. Utility
4. Expressing benefits as monetary values

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1. Effectiveness

Is the outcome of an intervention or service

measured in natural units
Example:
General outcome measures:
Cases successfully diagnosed
Cases successfully treated
Life years saved
Life years gained
Clinical indicator:
Number of asthma attacks avoided
Pain-free days
Percentage reduction in blood pressure

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1. Effectiveness
Quality of effectiveness information
Available from medical and health services literature
The quality of information/hierarchies of evidence:
I: Properly randomized controlled trial
II-1a: Controlled trial with pseudo-randomization
II-1b: Controlled trial without randomization
II-2a: Cohort prospective study with concurrent controls
II-2b: Cohort prospective study with historical controls
II-2c: Cohort retrospective study with concurrent controls
II-3: Case-control retrospective study
III: Large differences from comparisons between time and/or places with and
without intervention
IV: Opinion of respected authorities, based on clinical experience, descriptive
studies, or reports of expert commitees

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1. Effectiveness

35
1. Effectiveness

Effectiveness vs efficacy
Efficacy is the consequence (benefit) of a treatment
under ideal and controlled clinical outcomes and is
the outcome that is measured in RCTs
Assess the benefit and harm of the intervention when all
other factors are controlled
All real live does not behave like an RCTs
Different types of patients, different treatment processes,
different dose, be monitored less intensively
Thus: the intervention is likely to be less effective
Effectiveness: is the therapeutics consequence of a
treatment in real-world conditions
Effectiveness often < than its efficacy

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1. Effectiveness

Limitations
Only measure one part of an outcome and
may not reflect the overall impact of the
intervention on the patients health-related
quality of life (HRQoL)

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1. Effectiveness

Mortality used as an effectiveness measure

Problem associated with mortality:
People may die from other causes
Most illnesses affect quality of life rather than mortality
quality of life improvements due to intervention will not be
detected or included in the economic evaluation
Mortality is an insensitive measure that requires a study
with many patients followed up over a long period of time
People of different ages and sex have different risks of
mortality, so it is important that patient groups have similar
age and sex profiles if they are to be compared

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2. Quality of Life (QoL)

WHO Definition of Health

Health is a state of complete physical, mental
and social well-being and not merely the
absence of disease or infirmity
(WHO, 1948)
Quality of Life

An evaluation of all aspects of our lives,

including such things as where we live, how we
live, how we play, and how we work
(Bungay, 2005)
12 Domains:
Community - Housing - Self
Education - Marriage - Standard of living
Family life - Nation - Work
Friendships - Neighborhood - Health
Health Related Quality of Life
HRQoL encompasses only those aspects of our lives that are
dominated or significantly influenced by our personal health or
activities performed to maintain or improved health
(Bungay, 2005)
The concept of health-related quality of life refers to a person or
group's perceived physical and mental health over time
(National Center for Chronic Disease Prevention and Health Promotion)
Why HRQoL?
Because medical care is no longer limited to providing only
death-averting treatment
Arthritis, Diabetes condition having no cure but for which
medical treatment is targeted at controlling disease progression
and symptoms
Instruments

Generic
Not so sensitive within an individual disease state
More useful when looking at groups of patients who may
have different illnesses
Can be used to compare outcomes in different patient
groups
E.g: the Short Form 36 (SF-36) health survey
Diasease specific
E.g: Audit of Diabetes-Dependent Quality of Life
(ADDQOL-18)
(Elliott, 2005)
General Health Status Instruments

Generally evaluating at least 4 key health concepts (Bungay, 2005):

Physical functioning

The limitations or disability experienced by the patient over a

defined period
E.g: difficulties in walking, eating, dressing

Social and role functioning

Social functioning: the ability to develop, maintain, and nurture

mature social relationships

Role functioning: the impact health has on a persons ability to

meet demands of his or her normal life role

E.g.: frequency of visits with friends and relatives, frequency of
telephone contacts with close friends
General Health Status Instruments

Mental health
E.g: feeling of anxiety, nervousness, tenseness, depression,
moodiness
General health perceptions
Overall beliefs and evaluations about health

Questions covered: health preferences, values, needs,

attitudes
E.g: self-rating of health at present, expectations

regarding health in the future

General Health Status Instruments

Typical questions asked:

Yes Yes No
Limited Limited Not
a lot a litlle limited
at all
Walking more than a mile O O O
Bathing or dressing yourself O O O
Lifting or carrying groceries O O O
3. Utility

Is the value attached by an individual to a specific

level of health or a specific health outcome
Different individuals may attach different values to
the same health state
E.g:
Some people may be prepared to tolerate a lot of nausea
to allow them to be pain free.
Others may prefer to tolerate more pain and to reduce the
level of nausea
Important concept:
Utility measurement allows patients to value their health
status based on their own preferences

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3. Utility

Based on interval scales (go beyond generic

quality of life measures) Enable
quantitative comparison
Utility is used to attach a numerical value to
the value a person has for a particular health
state
Utility can be used to compare outcomes for
very different treatments in very different
patients groups
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3. Utility

Example:
Treatment A improves a group of patients health
by an average of 6 points on a utility scale
Treatment B improves a group of patients health
by an average of 3 points
Treatment A = 2 x as effective as treatment B
Treatment A might be surgery for a ruptured
Achilles tendon
Treatment B might be rhDNase for cystic fibrosis

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3. Utility
1. Direct measurement
Standard gamble
Time trade-off
Rating scales (visual analogue scale)
Equivalence technique
Ratio scaling
Person trade-off
2. Indirect measurement
a. Generic utility instruments
EQ-5D
SF-6D (Short Form six dimension)
HUI (Health Utilities Index)
QWB (Quality Well-Being)
15D (15 Dimension)
b. Disease specific utility instruments

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Time Trade-Off (TTO)

Simpler alternative to SG
People are ask to consider relative amounts
of time they would be willing to trade to
survive in a range of health states
Choose between spending a certain amount
of time in a defined state of ill health, or
moving to a shorter but healthier life

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Time Trade-Off (TTO)
Example:
State A:
Chronic renal failure
Have dialysis to stay alive
Provided at local hospital
Live 10 years
State B:
10 years in perfect health
What state would you choose? State B
The time in perfect health reduced to 1 year Choose state A
Repeated changing the amount of time in perfect health
Stop when cannot choose between the 2 states
Example: when time in perfect health = 5 years
What is the utility value? 0.5
5 years/10 years (time in health state B/time in health state A)

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 Euroqol (EQ-5D)
www.euroqol.org
Is a standardized instrument for use as a measure of health
outcome
Provides a simple descriptive profile and a single index value for
health status
Applicable to a wide range of health conditions and treatments
5 dimensions:
Mobility

Self-care

Usual activities

Pain/discomfort

Anxiety/depression

The score can be used in the calculation of a QALY

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 Euroqol (EQ-5D)

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 Euroqol (EQ-5D)

54
 Euroqol (EQ-5D)

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Whose Utility Values should be Used?

Healthcare professionals?
Patients?
The general public?

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4. Expressing benefits as monetary value

Willingness to pay (WTP) method

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Clinical Trial vs Pharmacoeconomics
Clinical Trial vs Pharmacoeconomics

Clinical Trial Pharmacoeconomics

Measure the efficacy Evaluating the drug in
and safety of a drug the real world
controlled environments measure efficiency of a
strict inclusion drug or its overall value
criteria, small sample in the health care
size system
Extrapolation of results Extrapolation of results
mostly applicable to monetary exchange
other country rate
Why do We Need Pharmacoeconomics?

To work out the best way to allocate scarce

health resources
Type of
Pharmacoeconomics
Analysis
Types of Pharmacoeconomics Analysis

Cost Analysis
Cost Minimization Analysis (CMA)
Cost Effectiveness Analysis (CEA)
Cost Utility Analysis (CUA)
Cost Benefit Analysis (CBA)
Cost Analysis

Analysis the costs of using a pharmaceutical

The emphasis is on total costs of a treatment
Note: Acquisition cost of a pharmaceutical is
a poor predictor of the total cost
Does not compare treatments or evaluate the
efficacy
Example:
Cost comparison of iv antibiotic administration
The costs of preparing and administering
several iv antibiotics in an Australian teaching
hospital were compared.
Standard regimens based on AB Guidelines
Cost included:
Acquisition cost of the drugs
Cost associated with drug delivery
Laboratory monitoring for potential toxicity

Plumridge RJ. Cost comparison of intravenous antibiotic administration. Medical Journal of Australia
1990; 153: 516-8
Cost comparison of iv antibiotic administration

Antibiotic Dose Doses Acquisition Delivery Laboratory Total cost Total cost
per day cost per cost per cost per per dose per day
dose dose dose

Aminoglycosides
Amikacin 500mg 3 $34.82 $9.38 $1.66 $45.86 $137.58
Gentamicin 120mg 3 $0.92 $4.55 $1.66 $7.13 $21.39
Netilmicin 150mg 3 $10.02 $4.55 $1.66 $16.23 $46.69
Tobramycin 120mg 3 $7.20 $4.55 $1.66 $13.41 $40.23

Cephalosporins
Cefotaxime 2g 3 $18.50 $5.63 - $24.31 $72.39
Cefoxitin 2g 4 $19.22 $5.63 - $24.85 $99.40

..

Plumridge RJ. Cost comparison of intravenous antibiotic administration. Medical Journal of Australia
1990; 153: 516-8
Conclusions Derived from the Study

The study highlights the need for hospitals to

develop a global view of intravenous drug
administration and to acknowledge the
interrelationships between departments
The cheapest drug is not always the least expensive
to administer
Relatively expensive antibiotics, particularly those
which are administered infrequently (e.g. daily), do
not require laboratory monitoring and have a low
side-effect profile, can be effective therapeutic
choices
Cost Minimization Analysis (CMA)

Compares two or more pharmaceuticals/treatments

that have equivalent outcomes
The least costly is the best value
Used when the clinical outcomes of the two
treatments are identical in similar populations of
patients
Identical outcome clinical trial (specify!)
Duration of treatment, efficacy, toxicity
The unit of CMA: currency ($, Rp, etc)
Ondansetron vs Tropisetron

Have equal effectiveness in reducing nausea

and vomiting
Outcomes are the same
Choose drug with the lowest total cost:
Acquisition cost of each drug
Consumables for administration
Medical and nursing time
Ranitidine vs Sodium Alginate
Mean cost per patient () Sodium alginate Ranitidine

Study medication 23.65 109.16

Other GORD drugs 72.46 25.67
GP consultations 81.01 71.49
Medications for AEs 3.72 1.20
Other costs for AEs 174.81 36.58
Investigations and
outpatient consultations 116.70 161.75

Total health cost 143.00 188.54

AE = adverse event

Paton S. Cost-effective treatment of GORD a comparison of two therapies commonly used in

general practice. British Journal of Medical Economics 1995; 8: 89-95
Other Examples

Compare the costs of the same drug

administered differently.
E.g. iv therapy given by nurses compared with the
same iv therapy given by doctors
Compare the cost of the same drug given in
different scenarios
E.g. iv antibiotics administered in hospital
compared with the same antibiotic given to
outpatients in a clinic or their home
Cost Effectiveness Analysis (CEA)

Compares the relative cost of therapies

having different outcomes, but where
outcomes can be compared
Having similar objectives (e.g. prevention or
treatment of same disease)
Outcome is the therapeutic effect
Measure is usually natural units
Units are:
Cost per life year saved
Cost per infection prevented
Calculating CEA
Average cost effectiveness
= Total cost
Total outcome
Antibiotic A:
Total treatment cost per patient $ 180

Has a cure rate of 90%

Average cost effectiveness = $ 180 = $ 200 per cured patient

0.90
Antibiotic B:
Total treatment cost per patient $ 200

Has a cure rate of 95%

Average cost effectiveness = $ 200 = $ 210.53 per cured patient

0.95
Comparing Two Treatments
Incremental Cost Effectiveness
the additional cost of a treatment for an additional benefit

Compare Antibiotic A & B

Antibiotic A : Antibiotic B :
total cost/px $180 total cost/px $200
cure rate 90% cure rate 95%
Incremental = cost of B cost of A .
cost effectiveness cure rate of B cure rate of A
of antibiotic A = 200 180
0.95 0.90
= an extra $ 400 per additional cured px

Using antibiotic B costs an extra $400 for each additional patient cured,
compared with antibiotic A
Interpretation

More effective

Less effective

Less expensive More expensive

Example

Misoprostol as prophylaxis for NSAID induced

ulcer
Ceftriaxone vs (Ampicillin + Gentamicin) for sepsis
Ceftriaxone vs Benzylpenicillin for Community
Acquired Pneumonia

The patients should come from patients groups

with comparable baseline demographics and
disease severity
Ceftriaxone vs (Ampicillin + Gentamicin)
For Sepsis Total Treatment Cost
Total Treatment Cost Ceftriaxone Amp + Gent

A. Drug cost ($) 123.26 80.77

B. Administration cost ($) 50.18 389.17
C. Hospitalisation cost ($) 3975.00 3975.00
D. Toxicity cost ($) 22.50 60.00
E. Monitoring cost ($) 0.00 52.31
F. Treatment value cost ($) 186.29 628.72

Total direct cost ($) 4357.23 5185.97

Ceftriaxone vs (Ampicillin + Gentamicin)
For Sepsis Cost Effectiveness
Cost Ceftriaxone Amp + Gent Net cost or
Effectiveness benefit of
Ceftriaxone

G. Cure rate 0.92 0.73

(% patient)
H. Total direct 4357.23 5185.97
Cost ($)

Incremental
CE ratio
Ceftriaxone vs (Ampicillin + Gentamicin)
For Sepsis Cost Effectiveness
Cost Ceftriaxone Amp + Gent Net cost or
Effectiveness benefit of
Ceftriaxone

G. Cure rate 0.92 0.73 - 0.19

(% patient)
H. Total direct 4357.23 5185.97 828.74
Cost ($)

Incremental
CE ratio 4736.11 7104.06 - 4361.79
Cost Utility Analysis (CUA)

Compares treatments that yield different

levels of health benefits, and enables effects
of treatment on quality of life and survival to
be considered together
CUA measures:
Cost incurred
Effectiveness of treatment
Effect of treatment on quality of life (Quality-
adjusted life years/QALY)
CUA

Similar to a CEA but incorporates a quality

of life component
CUA only suitable for the assessment of
chronic diseases (e.g. cancer, renal disease,
diabetes, asthma) acute conditions of
short duration (e.g. infections) do not have
enough impact on quality of life
CUA include an assessment of the patients
perception of their condition and treatment
Assessing Patients Perception

Rating scale
The patient rates their QOL on a scale from 0 (death) 10
(perfect health)
Sickness impact profile (SIP)
Medical outcomes study short form (MOS SF-36)
Nottingham health profile (NHP)
Activities of daily living (ADL) scale
Psycological adjustment to illness scale (PAOS)
Time trade off
The patient decides how much of their life would be willing
to trade off against this decrement in QOL
CUA

Example:
Omeprazole vs Fundoplication for moderate
to severe oesophagitis:

Heudebert GR, Marks R, Wilcox CM, Centor

RM. Choice of long-term strategy for the
management of patients with severe
oesophagitis: a cost-utility analysis.
Gastroenterology 1997; 112: 1078-86
Limitation of CUA

Not easy to obtain QOL information QOL

assessments for some conditions do not exist

Only suitable for evaluating chronic diseases

acute conditions (e.g. infections) do not
commonly impact on long term QOL and
would not significantly alter QALY
Cost Benefit Analysis (CBA)

Compares costs and outcomes in currency

values
Outcomes are not equal
The most difficult type of
pharmacoeconomics to perform
Primary problem: putting monetary value on a
health outcome (e.g. pain relief per life years
saved)
CBA

Example:
Prophylaxis of hepatitis A, typhoid and
malaria in travellers: a cost benefit analysis

Behrens RH, Robert JA. Is travel prophylaxis

worthwhile? Economic appraisal of
prophylactic measures against malaria,
hepatitis A, and typhoid in travellers. British
Medical Journal 1994; 309: 918-22
Steps in Conductiong a CBA

Step 1
Identify the intervention, program, therapeutic regimen and
research questions
Step 2
Identify and value all of the resources consumed or cost of
providing each intervention, program, or regimen
Step 3
Identify and value the benefit
Step 4
Sum the value of all cost and sum the value of all benefit
Steps in Conductiong a CBA
Net Benefits = Total Benefits Total Costs
Cost Benefit Ratio = Total Benefits
Total Costs
Cost Benefit Ratio = nt = 1[Bt/(1+r)t]
nt = 1[Ct/(1+r)t]
Bt = total benefits for time period t
Ct = total costs for time period t
r = discount rate
n = number of time periods
The decision:
If B/C > 1, benefits exceed costs socially valuable
If B/C = 1, benefits equal costs
If B/C < 1, benefits are less than costs not socially beneficial
Net Present Value (NPV)
Benefit Costs = NPV = nt = 1 [(Bt-Ct)/(1+r) t]
Example
Cost of Therapies ($)
Parameter Drug A Drug B

Costs
Acquisiton 300 400
Administration 50 0
Monitoring 50 0
Adverse Effects 100 0
500 400
Benefits
Days at work 1,000 1,000
Extra months of life 2,000 3,000
3,000 4,000

Benefit-to-cost ratio 3,000/500 = 6:1 4,000/400 = 10:1

Net Benefit 2,500 3,600
Example: Sample Comparison Using
Different Cost-Benefit Approach

Cost- Net Internal

Benefit Present Rate of
Program Costs Benefits Ratio Value Return
(t0) (t1)(B/C) (B-C) (B-C)/C

A $10,000 $15,000 1.5:1 $5,000 50%

B $100,000 $180,000 1.8:1 $80,000 80%
Comparison Table

Type Description Output Typical Unit

Cost Measures total cost of a Cost Currency
analysis healthcare program
CMA Compares 2 interventions (Potential) Currency
having equal efficacy cost saving
CEA Compares interventions with Cost per unit Currency per unit of
different health benefits of clinical outcome
outcome e.g. $ per mmHg drop in
BP
CUA Measures the cost per life-year Cost per unit Currency per unit of utility
gained, adjusted for quality of of utility e.g. cost per QALY
life
CBA Compares interventions with Benefit-to-cost A ratio or a total cost
different health outcomes, in ration, or saving in currency units
purely monetary terms (potential) cost
savings
What do I need to know to evaluate
pharmacoeconomics analyses?

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What do I need to know to evaluate
pharmacoeconomics analyses?
Aims
Are the aims of the study clearly stated?
Is there a well defined question to be answered by the study?
Is the perspective of the study clearly stated?
In what group of patients is the study being performed?
What is the clinical relevance of the study?
Common flaws: only one alternative therapy is studied and the
objectives are not clear

Sample selection
Is the patient group representative?
Are the types of patients suitable?
Are the patients demographic characteristics outlined?
Have the diagnostic criteria been specified?

92
What do I need to know to evaluate
pharmacoeconomics analyses?
Description of comparison
Are the competing alternatives clearly described?
Are the alternatives appropriate to the study objectives?
Are all relevant alternatives considered?
Were any important alternatives omitted?
Perspective
Is the study perspective appropriate?
Is the study perspective clearly stated (or is it implied by the costs
measured)?
Is it justified considering the study aims?
Outcomes
Have all outcomes been identified and measured?
Have all relevant and important outcomes and benefits been measured
in suitable terms, i.e. in monetary units, natural units (e.g. blood
pressure, mortality) or states of health (e.g. quality of life)?
Is the main end-point objective and relevant?
Has adequate time between allowed for the benefits to be seen?

93
What do I need to know to evaluate
pharmacoeconomics analyses?
Costs
Have all costs been identified and measured?
Have all the important and relevant costs been measured
accurately in appropriate units (relevant to the studys
perspective)?
Were capital costs as well as operating costs included?
Are the sources of the cost data included?
Have current prices been used?
Are the costs specific to geographical area or healthcare
scenario?
Discounting
Has discounting been applied to future costs and benefits?
Is the discounting rate clearly stated and justification given for
the rate used?

94
What do I need to know to evaluate
pharmacoeconomics analyses?
Sensitivity analysis
Has sensitivity analysis been performed?
Has a sensitivity analysis been included with justification given for
the range of values analysed?
Were the results sensitive to changes in values?

Incremental analysis
(if relevant)
Type of analysis
Has a suitable type of pharmacoeconomic analysis been used?
Results
Have the results been presented clearly?
Are the results reported fully, clearly and accurately

Do they allow consideration of different costs and benefits?

95
What do I need to know to evaluate
pharmacoeconomics analyses?
Discussion
Have the authors fully discussed their study?
Are the assumptions, limitations and possible biases discussed?
Are the results compared with those of previous studies addressing the same
issues?
Are the clinical implications mentioned?
Are all the issues of concern to the user discussed?
Are ethical issues considered?
Conclusions
What conclusions were drawn?
Are the conclusions valid and based on the results and design of the study?
Are the conclusions justified (e.g. one drug more cost effective than
another)?
Have recommendations been made?
Has the applicability of the findings to other settings and patient groups been
mentioned?

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Pharmaeconomics Limitations

Difficulty in capturing economic data

perspective of study and healthcare system
is different around the world
Differing treatment practices
many hospitals develop their own protocols
for management of particular conditions
Budget structures
Final Messages

Pharmacoeconomics provides the means to

show how economies can be made in theory
It is up to managers to effect the structural
changes that will make these economies
possible
TUGAS

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