An introduction to pharmacoeconomic evaluation in rheumatology

Abstract

AbstractPharmacoeconomics is a relatively new healthcare discipline that borrows from several disciplines including health economics, decision analysis and evidence‐based medicine. By using various techniques such as cost‐minimization analysis (CMA), cost‐effectiveness analysis (CEA), cost‐utility analysis (CUA) and cost‐benefit analysis (CBA), pharmacoeconomic evaluation attempts to instil the element of cost‐effectiveness into the clinical decision‐making process beyond the traditional approach of considering efficacy and safety. The ultimate aim of pharmacoeconomics is to assist the decision makers in achieving allocation efficiency in the healthcare system. This is in response to the increased need for accountability during the age of cost‐containment in healthcare. The rapidly increasing healthcare costs and the ageing of populations in the developed countries have contributed significantly to the need for consideration of effectiveness in the evaluation of any healthcare treatment, particularly in pharmaceuticals. The growth of this field has proceeded rapidly in the past decade as health policy makers have faced a continuing series of decisions about funding new clinical therapies in an era of increasingly constrained healthcare resources. However, economics of healthcare includes not just an assessment of the cost of a new therapy, but an assessment of its overall economic and clinical impact. The discipline of pharmacoeconomics is developed to fulfil this role. To date, the most successful applications of the principles of pharmacoeconomics are in the areas of purchase decision (e.g. decision for formulary inclusion), subsidy decision (e.g. level of subsidy for pharmaceuticals), establishing practise standards (e.g. development of clinical practise guidelines) and assessment of technologies (e.g. medical procedures and technologies). The proper application of pharmacoeconomic evaluation in clinical medicine would necessitate a multidisciplinary approach requiring expertise and inputs from practitioners from clinical medicine, biostatistics and psychometrics, among others. A properly conducted pharmacoeconomic evaluation would provide valuable insights for clinicians to allow the choosing of options representing the best value‐for‐money without compromising the quality of care delivered. The application of pharmacoeconomic principles in the practise of rheumatology will be illustrated using the example of a hypothetical example of evaluating an application for formulary inclusion of a COX‐2 inhibitor.