Pharmacoeconomic Principles Research Articles

Oral chemotherapy: rationale and future directions.

The expanding role of oral chemotherapy in oncology is suggested by the abundance of orally formulated agents currently in development. The pharmacoeconomic principles that drive oral drug formulation are discussed. Patient preference for oral therapy is identified as a second major impetus for the design of oral cytotoxics. While the rationale for oral formulations is apparent, substantial patient compliance and pharmacokinetic limitations have been identified for this route of administration. Specific aspects of bioavailability limitations and patient compliance are discussed. Relevant pharmacokinetic data for each orally formulated chemotherapy agent are compared and selected novel oral cytotoxics and cytotoxic modulators are discussed. A review of pharmacokinetic literature suggests substantial variability in bioavailability for many orally formulated cancer cytotoxics. While these findings are observed for all classes of oral drugs, the issue is especially critical for cancer chemotherapy, in which a narrow therapeutic index is frequently observed. Improved bioavailability and reduced interpatient biovariability are therefore desirable for new cytotoxic formulations. Pharmacologic manipulations to improve bioavailability and reduce costs are examined. Oral chemotherapy represents a fundamental change in contemporary oncology practice, driven by pharmacoeconomic issues, patient convenience, and the potential for improved patient quality of life. Novel cytostatic therapies that require protracted drug administration periods will also favor an oral formulation. While the use of oral chemotherapy may initially be limited to metastatic disease palliation, demonstration of equivalent efficacy would allow for its subsequent use in adjuvant settings. This efficacy is contingent on circumventing bioavailability limitations and patient noncompliance. The development of specific, low-toxicity inhibitors of CYP3A4, P-glycoprotein (P-gp), and other drug metabolizing enzymes such as dihydropyrimidine dehydrogenase represents a major innovative step in the successful formulation of oral chemotherapy.

New drugs in anaesthesia: can we afford them?

The most important challenge facing physicians today is the dilemma of providing high quality care in a fiscally responsible fashion. Cost can no longer be ignored. Pharmacoeconomics is a fundamental component of medical education. Economic issues should be an integral part of the drug development and clinical trials. While anaesthetists are concerned that the use of less expensive drugs may compromise patient outcome and satisfaction there is little evidence to support such concerns. This is a fertile area for intense future research. Pharmacoeconomics is a dynamic. The cost of drugs is not static, patterns of drug use shift rapidly and clinical practice is in a state of constant change. The answer to cost containment is not simply to cut, cap, delist or merely hope for the best, but rather to manage and modify practice while accommodating changing needs. Educational programmes, guidelines, department policies, system changes and financial incentives can be implemented to ensure consistent and enduring adherence to the principles of pharmacoeconomics and value based care. Some suggest that national societies should create guidelines for cost-beneficial practice. Others favour physician autonomy in drug selection. Changing physician behaviour is difficult. This change will occur gradually and will be the topic of many emotionally charged philosophical debates. There will be great reluctance to deny patients pharmacologically superior drugs based on cost alone, especially since drugs are such a small portion of the total costs. We must exercise caution to ensure that we don't become penny wise and pound foolish. Drug acquisition costs are only one element in a large and complex equation. Concentrating on acquisition drug cost may be dangerous, even naive if we fall prey to knowing the cost of everything but the value of nothing.

PHARMACOECONOMICS OF THE NEW ANTIPSYCHOTICS FOR THE TREATMENT OF SCHIZOPHRENIA

Inevitably, the greater availability of more costly antipsychotic medications has resulted in attempts to regulate the use of these agents. Early objections over the cost of treatment with clozapine or risperidone have in part been mollified by preliminary statistics on the cost effectiveness of these agents. However, this issue is complex and requires careful consideration of pharmacoeconomic principles in the development and clinical distribution of novel antipsychotics. Future cost-effectiveness studies need to consider a balance of public and private perspectives. These studies should be conducted in several settings, preferably also within the context of broader, multimodal treatment intervention strategies.

How to Apply Pharmacoeconomic Principles to Local Settings

Application of pharmacoeconomic principles to local settings requires an understanding of the subject matter of pharmacoeconomics. Pharmacoeconomics is the application of economics to the evaluation of healthcare interventions. It seeks to broaden the rational scientific basis for making choices between alternative forms of healthcare interventions by capturing and relating their costs and outcomes. Capturing costs requires addressing each form of cost and where they fall. An outcome of treatment implies a change in health status which can be identified and measured using health outcome instruments. Combining costs and outcomes in an analysis will indicate whether a particular healthcare intervention represents good value for money. The type of analysis used to relate costs and outcomes (e.g. cost-minimisation, cost-effectiveness, cost-benefit, cost-utility) will depend on the number, magnitude and distribution of the outcomes.

Pharmacoeconomics: where is the link with pharmacokinetics and biopharmaceutics?

Several, mainly macroeconomic factors are putting increasing pressure on health care budgets. These budget constraints lead to cost containment measures by all partners involved in health care. Pharmacotherapy, too, is facing an increasing involvement in health economics or outcomes research. This paper will first deal with some basic principles of pharmacoeconomics. The relationship with pharmacokinetics and biopharmaceutics has perhaps not yet been an issue as such, though it should be pointed out that they play a key role in the efficiency of drug use. Many of the basic R&D investments aimed at developing cost-effective medicines should be founded on adequate pharmacokinetics. Also a rational use of drugs in practice can be achieved by adequate drug monitoring, resulting in a gain in cost-effectiveness. Last but not least, pharmacokinetics and biopharmaceutics can offer opportunities for the rational use of new or existing pharmaceutical products and for the maintenance of a sufficient market share. Some of these more technical aspects are discussed in the second part of this presentation.

Pharmacoeconomics: where is the link with pharmacokinetics and biopharmaceutics?

Several, mainly macroeconomic factors are putting increasing pressure on health care budgets. These budget constrains lead to cost containment measures by all partners involved in health care. Pharmacotherapy, too, is facing an increasing involvement in health economics or outcomes research. This paper will first deal with some basic principles of pharmacoeconomics. The relationship with pharmacokinetics and biopharmaceutics has perhaps not yet been an issue as such, though it should be pointed out that they play a key role in the efficiency of drug use. Many of the basic R&D investments aimed at developing cost-effective medicines should be founded on adequate pharmacokinetics. Also a rational use of drugs in practice can be achieved by adequate drug monitoring, resulting in a gain in cost-effectiveness. Last, but not least, pharmacokinetics and biopharmaceutics can offer opportunities for the rational use of new or existing pharmaceutical products and for the maintenance of a sufficient market share. Some of these more technical aspects are discussed in the second part of this presentation.

Applications of Pharmacoeconomics in the Evaluation of Hospital Pharmacy Services

The evolution of the US health care system has driven institutions and professionals who practice in those institutions to deliver care in a more constrained and competitive environment. Quality care must be delivered with the least amount of resources possible. Because of the economic climate, institutions and professionals must now evaluate and develop their services. This article describes the application of pharmacoeconomics to hospital pharmacy services. Specific steps in conducting pharmacoeconomic analyses are discussed and illustrated by both hypothetical examples and recent examples in the literature. The marketing concepts of segmentation, targeting customers, and strategic planning will be discussed briefly to illustrate the application of pharmacoeconomics for streamlining services for maximum efficiency. Applying pharmacoeconomic principles to evaluate and develop services will provide information about the value and outcomes of those services. This information can be used to better target services to customers in need of those services, and to better use those services efficiently and effectively in an environment of scarce resources. Copyright © 1995 by W.B. Saunders Company

The economic evaluation of antibiotic therapy: relevance to urinary tract infection.

Economic analyses of health care interventions can be performed with various levels of sophistication but all aid in decision-making processes which determine funding priorities. Pharmacoeconomics is the application of health economic techniques to the evaluation of drug therapy. In this article the pharmacoeconomic principles underlying the rational choice of an antibiotic for the treatment of urinary tract infections are discussed. Examples of pharmacoeconomic, adverse reaction and non-compliance studies are quoted to illustrate these principles. Efficacy and freedom from adverse effects are the principal determinants of favourable cost-effectiveness ratios, rather than antibiotic costs alone. Doctors should bear this in mind when choosing drugs to treat urinary tract infection.