Drug Lit Exam 3- Pharmacoeconomics

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pharmaceutical care involves

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providers helping patients make choices

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Every choice that a patient makes which affects their health has several consequences (3)

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side effect risks
disease related life style changes
financial related lifestyle changes

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where do we get the "evidence" in literature to make pharmaceutical decisions?

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pharmacoecon studies

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definition of pharmacoeconomics

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description and analysis fo the costs of drug therapy to health care systems and society

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pharmacoeconomics is a discipline devoted to what?

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devoted to contrasting the full range of consequences acros alternative medical treatments to aid in decision making under uncertainty

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purpose of pharmacoeconomic studies

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1) Identifies, measures, and compares the cost and consequences (outcomes) of a specific therapy/drug

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pharmacoecon studies are useful for (5)

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1) making individual patient treatment decisions
2) making decisions about formulary mgmt
3) developing drug use guidelines
4) evaluating disease mgmt initiatives
5) determining the value of existing and proposed pharmaeutical serves

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studies are often what types of studies

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prospective (often cohort) observational studies

an also be retrospective
or RCTs

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very often economics modeling is used to provide what?

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provide a structure to organize the problem

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pharmacoeconomic studies benefits (3)

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facilitates outcomes (tradeoffs)

allows for assumptions to be made transparent

gives opportunity to yield "conditional" optimal outcomes (e.g. if event A occurs AND this B occurs...what's my consequence)

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explain the challenge of perspective in PE studies

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the big challenge is the perspective by which the study was conducted. is it pt perspective? quite often PE studies are done from broader population perspective (like costs to society in general) or from insurer (costs).

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PE studies attempt to do what?

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attempt to find optimal or best decisions for you to use as guidance

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3 things that are challenging/confusing with econ studies

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1) perspective that study was conducted from

2) patient pouplation and ability to generalize it to your patient
3) measurement issues (variability across papers)

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6 measurements that can vary from study to study

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cure rates
survival rates
QoL
adjusted survival rates
value of outcome (outcomes can be valued differently)
length in time for these outcomes

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3 COSTS that can be measured differently from study to study

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direct costs of treatment
indirect costs of life-style changes
indirect costs of side effects

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3 types of pharmacoeconomic studies

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1) clinical decision analysis (CDA)
2) cost effectiveness analysis (CEA)
3) cost benefit analysis (CBA)

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what is a decision tree used for?

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organizational tool used to provide a model by which treatment decisions can be made

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5 components of decision tree

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decision nodes (point where you must choose)

chance nodes
branches
event probability
outcomes

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3 steps to solve a decision tree

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1) calculate expected outcome following each chance node
2) Select decision at each decision node with best expected outcome
3) Then prune or ignore all branches

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Clinical decision analysis GOAL

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utilize the decision strategy to optimize an expected health outcome: this means you maximize expectations of a good outcome or minimize expectations of a bad outcome (like ADR)

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5 things CDA does not address, or it is shady on

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1) what are the other consequences not listed? (can only consider what you put into model)
2) how much do people benefit from the outcome? (can't determine the quantity of value)
3) is the health outcome valued more than it costs
4) whose benefit and costs are we talking about (payer? patient?)
5) should all patients be treated the same (using one model to apply to every pt)

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CEA (cost effectiveness analysis) what is this looking at

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looking at cost of achieving an improved single health outcome by a treatment as compared to an alternative treatment

expected net benefit of the treatment compared to the alternative- i.e if expected net benefits of treatment are better than alternative, should rec the treatment

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cost utility analysis - definition

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special type of CEA where health outcomes are not weighted for cost, but for quality of life.

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CE ratio

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cost to attain health outcome change. treatment is selected over the alternative if the decision maker values the outcome change greater than the cost to achieve that outcome change.

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CE ratio =

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expected cost (monetary) of treatment - exp cost of alternative divided by exp outcome of tretament - exp outcome (can be QoL or monetary too) of alternative

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Benefits of CEA (3)

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1) can use this info to help pt decide if it is worth purchasing more expensive treatments
2) evidence in the literature can be used to support this
3) you will have to help the patient extrapolate the evidence to their situation

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CBA: how are health outcome assessments made (2)

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health outcome assessments are made when costs and benefits are compared DIRECTLY using a "money metric"
it is the expected net benefit of the cost of treatment compared to costs related to the outcome

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CBA requires the researcher to assume what?

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health outcome has a monetary value or an amt that decision maker is willing to pay to attain the health outcome

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CBA results are conditional on what?

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the monetary evaluation applied- remember even the best estimates are only an average (how do we value a life?)

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appropriateness of CBA for individuals

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This is appropriate for populations but may be questionable for individuals (tends to be used more for formularies, etc)

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BEnefits of CBA (3)

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1) pt with the same clinical circumstances can make differnet treatment choies because of how they value the outcome gain, which allows you to individualize a lot more. Can value outcomes at diff lvls. wtf are these actual benefits
2) This approach is disconcerting if patient's outcome values differ becaues of their incomes??
3) CBA "evidence" in literature suggests an "optimal" treatment only for the pt that values outcome in the same way. otherwise results don't really apply.

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7 Questions to ask about evaluating pharmacoeconomic literature

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1) Was a well defined question posed (treatment vs. alternative)
2) was the perspective of the study clearly stated?
3) were the costs and benefits exhaustively measured to fit the prespective?
4) were the model parmaeters clearly stated and sourced?
5) was the analytical approach transparent leaving the reader the ability to "tweak" the results?
6) Did the authors perform a sensitivity analysis (vary parameters to see if results were robust to changes?)
7) Do the model parameter values fit your patient?

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Need to look up guidelines by sanchez

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