Role Of Pharmacoeconomics Research Articles

Role of Pharmacoeconomics in Precision Medicine

Role of Pharmacoeconomics in Precision Medicine

Pharmacogenomic and pharmacogenetic-guided therapy as a tool in precision medicine: current state and factors impacting acceptance by stakeholders

Pharmacogenetic/pharmacogenomic (PGx) testing is currently available for a wide range of health problems including cardiovascular disease, cancer, diabetes, autoimmune disorders, mental health disorders and infectious diseases. PGx contributes important information to the field of precision medicine by clarifying appropriate treatments for specific disease subtypes. Tangible benefits to patients including improved outcomes and reduced total health care costs have been observed. However, PGx-guided therapy faces many barriers to full integration into clinical practice and acceptance by stakeholders, whether practitioner, patient or payer. Each stakeholder has a unique perspective on the role of PGx testing, although all are similarly challenged with demonstrating or appraising its cost-to-benefit value. Coverage by insurers is a critical step in achieving widespread adoption of PGx testing. The acceleration of adoption of precision medicine in general and for PGx testing in particular will be determined by how quickly robust evidence can be accumulated that shows a return on investment for payers in terms of real dollars, for clinicians in terms of patient clinical responses, and for patients in terms of economic, health and quality of life outcomes. Trends in PGx testing utilization and uptake by payers in real-world practice are discussed; the role of pharmacoeconomics in assessing cost-effectiveness is highlighted using a case study in psychiatric care, and several issues that will affect adoption of PGx testing in the United States (US) over the next few years are reviewed.

Role of pharmacoeconomics in developing countries

Farmeconomia. Health economics and therapeutic pathways 2013; 14(1): 3-5ROLE OF PHARMACOECONOMICS IN DEVELOPING COUNTRIESMost developing countries lack policies that encourage the use of economic evaluations in medicine selection, be it for public funding, prioritization of aid or health insurance. In addition, relevant guidelines for reporting pharmacoeconomic analyses are not availa-ble in the majority of countries. Most deve-loping countries do have National Essential Medicine Lists to guide procurement and do -nation of medicines in the public sector [5]. However, the extent to which they employ the WHO’s evidence-based approach or other guidelines advocating the use of economic evaluation criteria in drug selection has not been established. Studies conducted by Mori et al. [6] and Gavaza et al. [7-9] in a number of countries in East, South and West Africa have documented a very low availability of pharmacoeconomic studies. Some of these studies were too poor in quality and narrow in scope to be appropriate as evidence to in-form decision-making. A similar trend has also been reported for developing countries in Asia [10-12].Another important observation is that, even when pharmacoeconomic studies are availa-ble, they are not systematically or consistently applied in decision-making [6,13]. Experien-ce shows that many pharmacoeconomic stu-dies were conducted long after the decisions had been made, sometimes simply to justify or disqualify those decisions, but more often for academic purposes. Cost-effectiveness studies of artemisinin-based combination therapies for malaria control, for example, were conducted in a number of countries af-ter the decisions to recommend the treatment in the respective malaria treatment guide-lines had already been made [14-16]. Low availability and inconsistent application of pharmacoeconomic data implies that phar-macoeconomics so far has had a limited role INTRODUCTIONThe high price of medicines and increasing expenditure on pharmaceuticals is a serious concern for governments in low-income countries where already over half of the population lacks regular access to essential medicines [1]. Currently, pharmaceuticals in low-income countries consume 30-60 percent of the recurrent healthcare budgets, yet the unmet need for medicines has been strongly associated with insufficient public spending on pharmaceuticals [2]. Poor fa-milies mostly rely upon public healthcare systems, where shortages of drugs are ram-pant [3]. In this situation the use of pharma -coeconomic principles is inevitable when an objective is to ensure that the limited re-sources are efficiently spent on drug thera-pies with large potentials to improve health. While developing countries commonly use National Essential Medicine Lists to prio-ritize the allocation of scarce public fun-ds between drug therapies, little is known about the role of pharmacoeconomics in such decisions. In this editorial we there-fore examine how pharmacoeconomics has influenced prioritization decisions between drugs in developing countries.WHAT IS PHARMACOECONOMICS?Pharmacoeconomic analysis involves the identification, measurement, valuation and comparison of costs and outcomes of alter-native drug therapies. The underlying aim is to maximize treatment outcomes within limited budgets [4]. Due to the high alterna-tive costs of scarce funds, it may be argued that pharmacoeconomics is relatively more important in developing countries than in developed countries. By alternative costs in this context we mean the health losses from making sub-optimal decisions.

The role of pharmacoeconomics in current Indian healthcare system.

Phamacoeconomics can aid the policy makers and the healthcare providers in decision making in evaluating the affordability of and access to rational drug use. Efficiency is a key concept of pharmacoeconomics, and various strategies are suggested for buying the greatest amount of benefits for a given resource use. Phamacoeconomic evaluation techniques such as cost minimization analysis, cost effectiveness analysis, cost benefit analysis, and cost utilization analysis, which support identification and quantification of cost of drugs, are conducted in a similar way, but vary in measurement of value of health benefits and outcomes. This article provides a brief overview about pharmacoeconomics, its utility with respect to the Indian pharmaceutical industry, and the expanding insurance system in India. Pharmacoeconomic evidences can be utilized to support decisions on licensing, pricing, reimbursement, and maintenance of formulary procedure of pharmaceuticals. For the insurance companies to give better facility at minimum cost, India must develop the platform for pharmacoeconomics with a validating methodology and appropriate training. The role of clinical pharmacists including PharmD graduates are expected to be more beneficial than the conventional pharmacists, as they will be able to apply the principles of economics in daily basis practice in community and hospital pharmacy.

Is There a Role for Pharmacoeconomics in Decision Making?

Is There a Role for Pharmacoeconomics in Decision Making?

Achieving value: The role of pharmacoeconomics

Health expenditures worldwide have increased to an average of 9.5 percent of Gross Domestic Product (GDP) within Organisation for Economic Co-operation and Development (OECD) nations, representing an average growth rate of 4.1 percent per year [1]. Pharmaceuticals and other durable medical goods comprise almost 17 percent of total health expenditures, with the large majority of healthcare costs attributed to professional services and hospital care [1]. With aging global populations, several countries have forecasted higher percentages of GDP to be consumed by healthcare over the next several years and decades. While advances in health technology over the last several decades have greatly improved life spans and welfare to society, it is often perceived that the costs of these innovations have not been exceedingly offset by their benefits [2,3]. Assessing healthcare expenditures involves the integration of several complex issues that surround coverage, supply and demand, pricing dynamics, and characteristics of the innovations utilized [4,5]. Healthcare policy is also challenged to achieve an ethical balance between patient outcomes and that of fiscal ability [4]. As illustrated in Fig. 1, policymakers often seek to optimize elements within ‘The Iron Triangle of Health Care Policy,’ which is a triumvirate of cost, access, and quality based upon the numerous stakeholders that are present [6]. Achieving a balance across cost, access, and quality is challenging, particularly given that the value attributed to each of these elements differs based upon the perspective of stakeholders within healthcare. To illustrate, both providers and patients may typically seek to maximize access and quality, often at the result of increased costs. As a discipline, pharmacoeconomicsoffers a comprehensive analytic framework to evaluate the comparative value of innovations offered to society. Appearing in Fig. 2, pharmacoeconomics seeks to assess the costs and resources consumed for healthcare technologies relative to the patient outcomes achieved (e.g., economic, clinical,

Is There a Role for Pharmacoeconomics in Developing Countries?

Is There a Role for Pharmacoeconomics in Developing Countries?

Is There a Role for Pharmacoeconomics in Developing Countries?

Is There a Role for Pharmacoeconomics in Developing Countries?

Is There a Role for Pharmacoeconomics in Developing Countries?

Is There a Role for Pharmacoeconomics in Developing Countries?

Relationship between clinical effectiveness and pharmacoeconomic cost in patients with diabetes mellitus

Relationship between clinical effectiveness and pharmacoeconomic cost in patients with diabetes mellitusTherapeutic practices and effectiveness have a crucial impact on healthcare system costs in diabetes mellitus treatment with significant economic implications. Encompassing up to 15% of the healthcare budget in the Slovak Republic, diabetes mellitus imposes a huge economic burden on the Slovak healthcare system.The paper analyzes the treatment needs and medication costs for diabetes between 2004 and 2010 in the Slovak Republic. Both insulin and oral antidiabetic therapy are available for all patients depending on the severity of the disease. The costs analysis clearly indicates a great impact of diabetology on healthcare. The results of this work have confirmed that diabetes mellitus is a costly disease, and the costs are expected to grow further. With respect to the increasing demand and limited resources, there is a growing need for additional economic analyses. To achieve control of costs in the decision making processes in the Slovak Republic, the role of pharmacoeconomics should be strengthened.

Is There a Role for Pharmacoeconomics in Developing Countries?

The special issue of PharmacoEconomics pertaining to developing nations was a welcome move, with authors discussing various themes relating to pharmaceutical economics. The topics discussed included cost-effectiveness analyses and the future of health technology assessment (HTA) in healthcare decisionmaking in the greater Asia region. However, papers in this special issue did not provide an answer to a fundamental question: why is pharmacoeconomics vital for developing countries? Pharmacoeconomics is a complex science and its practical utility depends on the context in which it is being applied. To appreciate the true value of this ‘science’ as a decision-making tool, it is important to elaborate on the context within which healthcare decisions are being made. Furthermore, an understanding of the local health system is also required in order to establish whether complex economic techniques need to be applied and whether they are feasible and valuable tools for a particular jurisdiction. We argue that there is a need for a model that could aid in determining the perceived need and benefits of using pharmacoeconomics in formulary development in a given developing country. However, we do not present a full model; rather, we highlight some of the components that could be used to build such a model. Health and pharmaceutical indicators from international agencies, evidence-based pharmacy-system research as well as the literature concerning ‘how people perceive pharmacoeconomics’ in developing countries could serve as these components. 1. The Use and Understanding of Pharmacoeconomics in Developing Countries

The role of pharmacoeconomics in formulary decision making in different hospitals in Riyadh, Saudi Arabia

Objective To assess the trend of using pharmacoeconomic information by Pharmacy and Therapeutics (P&T) committees when making formulary decisions. Design A cross-sectional study conducted in 2007, using structured survey questionnaires which were distributed to members of the P&T committees in 11 different hospitals in Riyadh, Saudi Arabia. Results A total of 100 survey questionnaires were sent to head of pharmacy departments of 11 different hospitals in Riyadh, Saudi Arabia. Out of these, 48 questionnaires were completed and returned. Of the total respondents participated in the study, 64.58% were medical doctors and 16.66% were pharmacists and 75% of the respondents said they have applied pharmacoeconomic evaluations in their decision making process. More than 80% of the respondents perceived that they had a fair knowledge of pharmacoeconomics. Approximately 80% of respondents expressed some degree of agreement that pharmacoeconomics should be applied as a decision making tool. The majority of decision-makers (95%) expressed the interest in attending workshops on pharmacoeconomics. Conclusion The study showed that pharmacoeconomics can play an important role in the P&T committee formulary decisions. However, more education to health care professionals and to hospital administrators should be conducted to facilitate the use of such a tool. Also, hospitals should recruit health care professionals with pharmacoeconomic expertise to manage limited health resources in the best way available.

From NCE to NICE: the role of pharmacoeconomics

Medicines now cost the NHS more than £13 billion per annum, and account for around 10% of the overall budget. An ageing population, together with technological advances, means that the year-on-year rise in the total costs of medicines is likely to continue, despite the inevitable budgetary cuts in the wake of the economic downturn. The resulting scarcity of monetary resources necessitates trade-offs, which result in an opportunity cost, that is, the benefits forgone in the choice of one expenditure over others. The notion of opportunity cost is central to the activities of organizations such as the National Institute of Health and Clinical Excellence (NICE), the Scottish Medicines Consortium (SMC) and the All Wales Medicines Strategy Group (AWMSG), which are charged with making judgements on whether medicines are to be made available to NHS patients. The establishment of evidence-based medicine in the eighties, as the basis for more effective prescribing, was followed in the nineties by a recognition of the importance of value for money considerations for more efficient (cost-effective) prescribing. Health economic evidence, pharmacoeconomic if pertaining to medicines, is now accepted as an essential component of health technology appraisal both in the UK and further afield.

Can pharmacoeconomics and outcomes research contribute to the empowerment of women affected by breast cancer?

Breakthroughs in genetic testing have informed patients and physicians in the treatment of breast cancer; however, they have also added to the complexity of decision-making. Genetic testing for breast cancer susceptibility not only changes treatment and screening options, but also challenges the way in which interventions are evaluated. While comparative effectiveness and cost–effective analysis methods are now standard for evaluation at the societal level, technologies such as genetic testing require us to consider the role of patient preference, especially as we move towards more personalized approaches to medicine. In this review, we discuss the changing role of pharmacoeconomics and outcomes research by highlighting how the discipline could use patient preference methods, such as conjoint analysis, to promote shared decision-making and to empower breast cancer patients. By adopting these methods we could move our focus from what is best for payers or society to one that applies scientific methods to identify what is best for patients.

Antibacterial treatment strategies in hospitalized patients: what role for pharmacoeconomics?

Antimicrobial agents continue to account for a significant portion of institutional pharmaceutical expenditures. Pharmacoeconomic analysis is a valuable tool in assessing antibacterial agents for their place in institutional formularies. This article reviews various types of pharmacoeconomic analyses, their respective limitations, and their roles in the antibacterial formulary decision-making process. We also discuss the current state of the antibacterial pharmacoeconomic literature, including the economic impact of antimicrobial resistance.

The Pharmacoeconomics of Alternatives to Allogeneic Blood Transfusion

SUMMARY Background and Objectives: Pharmacoeconomics provides a standardized methodology for valid comparisons of interventions in different fields of healthcare. The role of pharmacoeconomics in the safety of blood, blood products and alternatives has however been very limited up to today. This paper discusses the pharmacoeconomic evaluations of alternatives to blood transfusion that have been published in the scientific literature. Methods: We reviewed pharmacoeconomic methodology with special reference to cost‐effectiveness and cost‐utility analysis. We searched the literature for such cost‐effectiveness analyses related to alternatives to blood transfusion. Results: Net costs per quality‐adjusted life year (QALY) gained varied from cost‐saving for reduction of blood transfusions by antifibrinolytics and for analyses which included assumed complications caused by transfusion‐related immunomodulation to more than a hundred millions of US$ per QALY gained for preoperative autologous donation by transurethral prostatectomy patients and epoetin augmentation of preoperative autologous donation. Conclusions: Currently preoperative autologous blood donation with or without epoetin augmentation and epoetin in the absence of autologous transfusion cannot be regarded as cost‐effective healthcare interventions for the general population. Perioperative use of antifibrinolytics may be cost‐saving, but at present evidence is scarce. Cost‐effectiveness of alternatives to blood transfusion may improve if the impact of adverse effects of allogeneic transfusion, such as immunomodulation, bacterial infection and TRALI, can be further substantiated, if the costs of allogeneic blood transfusion continue to rise due to the introduction of (more) safety measures or if donor blood becomes scarce.

Pharmacoeconomic issues in onychomycosis.

The importance of health economics (the application of economics to healthcare and medicine) has grown significantly in recent years as the need to maximize the use of limited healthcare resources has increased. The role of pharmacoeconomics (the application of health economics to pharmaceuticals) is to provide a method that evaluates outcomes and costs of treatment at the same time, thus providing an aid to better decision-making. However, there remains some uncertainty within the medical community about the usefulness of pharmacoeconomic data. Reasons for this include a poor understanding of the purpose and outcome of pharmacoeconomic studies, inconsistent use of terminology, and a perception that freedom of choice of prescriptions is restricted. To optimize the medical management of patients with severe onychomycosis, two pharmacoeconomic evaluations of amorolfine were undertaken. In a comparison of topical amorolfine + oral terbinafine vs. oral terbinafine alone, treatment with the topical/oral combination for a period of up to 12 weeks resulted in an improved outcome compared with the oral drug alone. A second study with topical amorolfine + oral itraconazole showed that treatment for a period of 6 weeks was the preferred cost-effective treatment option. While combination therapy might seem to be a more costly option, pharmacoeconomic studies have clearly shown that treatment of onychomycosis with amorolfine, in combination with either oral terbinafine or oral itraconazole, is both cost-saving and cost-effective compared with oral treatment alone.

Pharmacoeconomics for the Pharmaceutical Industry in Europe

The role of pharmacoeconomics has evolved as a consequence of cost-containment pressures from the pharmaceutical industries’ ‘external environment’. This paper reviews the published literature on the role of pharmacoeconomics in the pharmaceutical industry and gives a historical background and state-of-the-art picture on the function and importance of pharmacoeconomics for the different stakeholders and decision makers in the healthcare area, with a special focus on the pharmaceutical industry in Europe. Pharmacoeconomics is analysed as a part of decision processes at several stages of drug development and drug marketing. The review focuses on the practices of the application of pharmacoeconomics in various countries in Europe, and the drivers for the development of pharmacoeconomics within pharmaceutical companies are described. Investments made by companies with respect to the pharmacoeconomic function in terms of personnel and budget are derived. It is expected that within Europe, the pharmacoeconomic function will continue to grow in importance in the pharmaceutical industry in the coming years and will have at least a moderate commercial impact on pharmaceutical manufacturers through the pricing and reimbursement mechanism.

Pharmacoeconomics for the Pharmaceutical Industry in Europe

The role of pharmacoeconomics has evolved as a consequence of cost-containment pressures from the pharmaceutical industries’ ‘external environment’. This paper reviews the published literature on the role of pharmacoeconomics in the pharmaceutical industry and gives a historical background and state-of-the-art picture on the function and importance of pharmacoeconomics for the different stakeholders and decision makers in the healthcare area, with a special focus on the pharmaceutical industry in Europe.

Pharmaco-economics of blood transfusion safety: review of the available evidence.

Pharmaco-economics provides a standardized methodology for valid comparisons of interventions in different fields of health care. The role of pharmaco-economics in the safety of blood and blood products has, however, been very limited to date. This review discusses the pharmaco-economic evaluations of strategies to enhance blood product safety that have been published in the scientific literature. We reviewed pharmaco-economic methodology with special reference to cost-effectiveness analysis. We searched the literature for cost-effectiveness in blood product safety. Net costs per quality adjusted life-year (QALY) gained varied from cost-saving for human immunodeficiency virus (HIV)- and hepatitis C virus (HCV) antibody screening and leucoreduction to several million US dollars per QALY gained for solvent-detergent treatment of plasma, nucleic acid amplification testing and HIV p24 antigen testing. To date the safety of blood transfusion has been largely determined by available technology, irrespective of pharmaco-economics. Net costs up to several million US dollars per QALY gained were found for interventions implemented.