Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Average standard pneumonia treatment cost (Rp) Exchange rate to US$1 (Rp)
15000 16000
12000
12000
9000
8000
6000
4000
3000
0 0
Mali
Egypt
China
Indonesia
Thailand
Tunisia Developing countries
Jordan
(24 - 66 %)
Argentina
South Africa
0 10 20 30 40 50 60 70
PharmacoEconomics
• Adding drugs to the formulary involves careful
consideration of:
– Efficacy
– Safety
– Quality
– Cost
• Cost factors are becoming more important
• Science of pharmacoeconomics is emerging
– Pharmacoeconomics
– Cost (total resources consumed in producing a good
or service)
– Price (the amount of money required to purchase an
item)
Adding drugs to the formulary
clinic available Introduced
GI ulcer H2-antagonist PPI
Arthritis NSAID COXIB,
anti-TNF agents
Mental TCA SSRIs, Atypical
health Anti-Psychotics
Women’s - (osteoporosis) biphosphonate
health
AIDS - Protease
Inhibitors/cocktail
Medical Outcomes
ECHO Model
pharmaco- outcomes
economics research
pharmaceutical
care
Definition
• Economic outcomes measure that focuses
on the evaluation of pharmaceutical
products and pharmaceutical services
Clinical
Economic
Humanistic
cost-minimization
cost-utility
Cost-Minimization Analysis
• Compares the total relevant cost-
difference between treatment
alternatives (products or services) that
are considered to produce identical
outcomes
Clinical
Economic
Humanistic
Cost-Minimization Analysis
Examples:
• comparing an AB rated generic drug to its
brand name equivalent
• comparing the cost of a multiple dose
schedule to a once daily schedule that is
equally safe and effective
• analyzing the cost of administering and
monitoring the same drug in two different
settings
Generically Equivalent
• Pharmaceutically equivalent
• Therapeutically equivalent
• The same drug with the same effect,
but the product is from a different
manufacturer
• AB rating in “Orange Book”
Frothingham R.
"Me-Too" Products — Friend or Foe?
NEJM 350(20):2100-2101,2004
• The proliferation of "me-too" drugs leads to
beneficial cost reductions, but it may also put
patients at risk.
• Each me-too drug comes to the market with
limited clinical experience as compared with
compounds already in use.
– Five me-too drugs in the statin and quinolone classes
have been withdrawn or restricted because of serious
adverse effects that were not recognized until months
or years after their approval
– temafloxacin, grepafloxacin, cerivastatin, sparfloxacin,
and trovafloxacin.
• Therefore cost–safety issue has no simple
answer.
Original vs "Me-Too" prices
Friend or Foe?
Nimesulide Pharmaceutical Co. Price (Rp)/100mg
Original
Aulin® Gala 2.950,-
Nimed® Schering 2.950,-
“Me-Too”
Arnid® Pharos 2.750,-
Ilusemin® Phapros (?)
Ximede® Combiphar 3.200,-
MOST EXPENSIVE
THERAPY
THERAPEUTIC
FAILURE
Cost-Effectiveness Analysis
• Compares the total relevant cost of
therapy to the effectiveness when the
outcomes for the alternatives are NOT
equal
Clinical
Clinical
Economic
Economic
Humanistic
Cost-Effectiveness Analysis
Example:
_____________________________________________________
Total Cost/ Lives Saved/ Average CE
100 Patients 100 Patients Ratio
IV I
The new treatment is The new treatment is
Less effective and more more effective and
expensive more expensive
Difference in
effects
III II
The new treatment is The new treatment is
less effective and more effective and
less expensive less expensive
Less $ More $
Worse A B
outcome
Better C D
outcome
Cost Utility Analysis
• Evaluates the value of an intervention or
a program against the value of the
outcome in terms of quality-adjusted life
years (QALYs)
Clinical
Economic
Humanistic
Cost Utility Analysis
Incremental Cost Utility Ratio (ICUR)
= $ 6400 / QALYS
_____________________________________________________
Average CU Ratio Interpretation
______________________________________________________________________
Less than $20,000/QALY Good value
$20,000 to $100,000/QALY Intermediate value
More then $100,000/QALY Cost prohibitive
_____________________________________________________
Cost-Benefit Analysis
Evaluates the value of all resources
consumed in implementing a program or
intervention against the value of the
outcome
Clinical
Economic
Humanistic
Cost-Benefit Analysis
• Example:
_____________________________________________
Cost Benefit Average B:C Ratio
New Benefit/Cost
Service $25,000 $45,000 1.8:1
_____________________________________________
Commonly Prescribed Drugs
• Anti-inflammatory agents
• Analgesic agents
• Antimicrobial agents
(antibiotics, antifungal, antiviral)
• Corticosteroids
• Antianxiety/sedative agents
**Adjuvant analgesic agents**
Outcome Measures
Clinical Humanistic
Disease Indicator Economic Outcome
Outcome Outcome
Renal failure
Cost/ mmHg BP
Stroke
Hypertension BP
MI
QOL Cost/stroke avoided
Cost/life year saved
Death
Angina
Cost/MI avoided
Hyperlipidemia LDL levels MI QOL
Cost/point in LDL
Death
Retinopathy Cost/change in A1C
A1C Nephropathy
Diabetes QOL Cost/kidney transplant
BG levels Death avoided
Exacerbation
FEV, Cost/symptom free
Asthma event QOL
day
peak flow
Death
Outcome Measures
for pain management
Clinical Humanistic Economic
Agent Indicator
Outcome Outcome Outcome
CV event Cost/ mmHg BP
NSAID pain GI event QOL Cost/stroke avoided
Renal failure Cost/life year saved
A B
Cost
C D
Effectiveness
Kaskade peresepan di klinik pribadi
Keadaan awal terapi Simtom baru terapi ikutan
Nyeri
dengkul
AINS
Nyeri
ulu hati
antasida
konstipasi
laksansia
diare
dst
PAIN
NSAID
Rp
Anti-
Rp
diuretic Rp
hypertension Rp
misoprostol Rp
antacid
Prescribing Cascade
PAIN
ALZHEIMER
CANCER DISEASE
NSAID=Rp
Rp Rp Rp Rp
Iatrogenic Cost
Pharmacoeconomics
pharmacotherapeutics
say NO say YES
- -New
- + Now what ?
$$ Medications
safety _
+++ do it!
Effectiveness
Dangerous person
Wishing to eliminate a Wishing to eliminate a
president of another sign or symptom of a
country disease
Bombing all areas of Giving an expensive
the country drug & polypharmacy
Killing the people in Increasing ADRs &
that country iatrogenic disease
Spending a lot of
Spending 20 M US$
money
But then offering only But it cloud be then
200,000 US$ to whom overcome by the
could bring the head of cheapest drug
the president
KEBANGGAAN INDONESIA
UNTUK DUNIA
announcement and invitation
KEBANGGAAN INDONESIA
UNTUK DUNIA
Is evidence really evidence?
The Evidence Pyramid
META-ANALYSIS
DB
RCT
RCT
Cohort studies
Case control studies
Case series
Case reports
0 10 20 30 40 50
Number of studies