Pharmacoeconomics Block 1

Front 1

the description and analysis of the costs and consequences of pharmaceutical products and services and their impact on individuals, healthcare systems and society

Back 1

pharmacoeconomics

Front 2

attempts to identify, measure and evaluate the end result of health care services in general

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outcomes research

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broader umbrella over pharmacoeconomics

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outcomes research

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ECHO model stands for

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economic perspective
clinical perspective
humanistic perspective
"outcomes"

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there is a rising cost of....

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healthcare spending

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what is driving the rising cost of healthcare spending? (4)

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inefficient incentives
technology and prescription drugs
chronic diseases on the rise
administrative costs

Front 7

what are the top 3 categories in total healthcare spending

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1. hospital
2. physicians
3. prescription drugs

Front 8

% of pharmacy cost to health plan based on specialty pharmacy

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50%

Front 9

what are descriptions of specialty pharmacy? (3)

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service associated with drug
expensive drug
relates to limited population

Front 10

affordable care act: government v. health insurer premiums and practices, Health Insurance Exchange, payment reforms reducing payments for

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greater government oversight and regulation of health insurer premiums and practices, increasing competition and price transparency in sale of insurance policies, treatments and hospitalization resulting from errors and poor quality

Front 11

affordable care act funding what type of research, how much?

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comparative effectiveness research (CER)

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affordable care act: refocusing medical delivery systems to be? improve? (2)

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patient centered, coordination and quality of care

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______ is a major cost center in U.S. hospitals, but it also plays a critical role in ____________ and ____________

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pharmacy, patient safety, quality of care

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managed care applications: enhanced focus on _____________ decisions

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population-level

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hospital/clinical applications in pharmacoeconomics: assesses effects of? evaluating products for? assessing the? evaluating the value of?

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clinical guidelines, P&T review, pharmacoeconomics literaure, innovative pharmacy services

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retail pharmacy applications: assessing the value of? evaluating the economic value of? primary research site for?

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innovative care delivery mechanisms, emerging technologies, humanistic data collection

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compares different interventions and strategies to prevent, diagnose, treat and monitor health conditions

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comparative effectiveness research (CER)

Front 18

role of pharmacist in outcomes research: identify? evaluate what? design what? analyze and ***** what? identify and execute what? monitor what? present what? repeat what?

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identify topic areas for evaluation
evaluate the literature
design the evaluations
analyze and assess results
identify and execute intervention strategies
monitor results
present results
repeat the evaluation process

Front 19

core payer deliverable which communicates clinical, safety, economic and quality of life value proposition of medical products to payers and providers

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AMCP dossiers

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widely adopted with US payers and is a standard deliverable, particularly to support the launch of a new product or indication

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AMCP formulary dossiers

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pharmaceutical industry applications: generating ________ to support product portfolio? communicate _______ to multiple stakeholders? data for? helping to establish what?

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generating value evidence to support product portfolio
communicating value to multiple stakeholders
helping to establish pricing decisions
data for product labeling

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summary slide

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1. trends in overall health care costs and pharmacy costs specifically heighten the need for careful assessment of the costs and outcomes of drug therapy and services
2. health care reform and the rise of comparative effectiveness research provides an opportunity for pharmacists to show value
3. pharmacoeconomics principles will be valuable in multiple practice settings
4. pharmacists with applicable skills in pharmacoeconomics will differentiate themselves in assessing and demonstrating value

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the value of resources consumed by a program or treatment alternative

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costs

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the effects, outputs, and outcomes of the program or treatment alternatives

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consequences

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pharmacoeconomics focuses on assessing the _____ and ______ of treatment alternatives

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cost, and consequences

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type of cost where resources consumed in the prevention, detection, and treatment of a disease or illness

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direct costs

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overhead costs that are relative constant and not influenced at treatment level

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fixed

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type of cost that vary as a function of volume

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variable

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costs that contribute to the portion of gross national product spent on health care

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direct medical cost

Front 30

quantify the fundamental transactions associated with medical care

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direct medical cost

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direct medical costs are subdivided into what two categories

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fixed (not influenced at treatment level), variable (vary as a function of volume)

Front 32

type of costs where these are examples: medications, medication monitoring, diagnostic tests, hospitalizations, home health, nursing service, etc

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direct cost

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direct non-medical costs are costs for ______________ that are the result of ______________

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non-medical services, illness or disease

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type of direct costs that do not involve the purchase of medical services

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direct non-medical costs

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examples include: travel costs to receive care, child care services if needed related to care

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direct non-medical costs

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costs that result from morbidity or mortality

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indirect cost

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type of costs that is related to changes in production capacity that result from disease or health care interventions

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indirect cost

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morbidity costs: incurred from?
mortality costs: incurred from?

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missing work
premature death

Front 39

this type of method values morbidity and mortality losses based on an individual's earning capacity

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human capital method

Front 40

patients are explicitly asked how much money they would be willing to spend to reduce the likelihood of illness

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willingness-to-pay

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in the human capital method, the value of a life is directly related to?

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income

Front 42

these are costs incurred that represent nonfinancial outcomes of disease and medical care

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intangible care

Front 43

the value of resources consumed by a program or treatment alternative

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cost

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the effects, outputs, and outcomes of the program or treatment alternative

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consequences

Front 45

pharmacoeconomics focuses on assessing the _____ and _____ of treatment alternatives

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cost, consequence

Front 46

resources consumed in the prevention, detection, and treatment of a disease or illness

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direct cost

Front 47

costs that contribute to the portion of gross national product spend on health care

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directly medical costs

Front 48

direct medical costs quantify the fundamental transactions associated with

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medical care

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overhead costs that are relate constant and not influenced at treatment level

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fixed

Front 50

vary as a function of volume (cost)

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variable

Front 51

examples of this type of cost include: medications, diagnostic tests, clinic visits, etc

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direct cost

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costs for non-medical services that are the result of illness or disease

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direct non-medical costs

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examples of cost include: travel cost to receive care, child care services if needed related to care

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direct non-medical costs

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indirect costs result from ______ and _______

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morbidity and mortality

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related to changes in production capacity

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indirect costs

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indirect cost incurred from missing work

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morbidity cost

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indirect cost incurred from premature death

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mortality cost

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values morbidity and mortality losses based on an individual's earning capacity.

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human capital method

Front 59

in the human capital method, the value of a life is directly related to

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income

Front 60

patients are explicitly asked how much money they would be willing to spend to reduce the likelihood of illness

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willingness-to-pay

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costs incurred that represent nonfinanical outcomes of disease and medical care

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intangible costs

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examples of cost include: pain/suffering, fatigue, anxiety

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intangible costs

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examples of cost include: lost productivity

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indirect cost

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perspective is point of view from which

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economic analysis is performed

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value of treatment will be heavily dependent on the

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point of view taken

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perspective example: what patient pays for product or service

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patient perspective

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perspective example: how much will cost to give service to patient

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provider perspective

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perspective example: charges for health care products and services allowed or reimbursed by the payer

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payer perspective

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perspective example: consider the benefit of society as a whole

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societal perspective

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the value of the best-forgone option or next best option

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opportunity cost

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cost v. charge

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cost = amount to provide the service or good
charge = what is billed to the payer

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what is standardization of costs

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bring past costs to the present

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needed if costs are estimated based on dollars spent or saved in future years

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discounting

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what is the % of discount typically

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3-6%

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can be calculated for future expenditures and savings from the discount rate

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present value

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discounting v. standardizing

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d: costs estimated based on dollar spent/saved in future
s: bring past costs to present

Front 77

reflect the cost per outcome of one alternative INDEPENDENT of other alternative, do NOT compare

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average costs

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change in costs and health enefits from a one-unit expansion, do NOT compare alternatives

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marginal cost

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extra costs required to purchase additional unit of effect, DO compare to alternatives

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incremental cost

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compare to alternative or not?
average, marginal, incremental

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a: no
m: no
i: yes

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major sources of data: categories and subcategories

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internal data sources "PECC"
patient surveys, electronic medical records, claims, chart abstraction

external data sources "PL"
publically-available databases, literature

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claims data describes the ______ interaction between patients and the healthcare delivery system

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billable

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4 categories of claims data

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outpatient
inpatient
pharmacy
enrollment data/demographics

Front 84

public databases are typically one of two categories

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claims data from medicare and medicaid
national health surveys

Front 85

most frequently-used data source for pharmacoeconomic analyses, especially when developing economic models or decision analysis

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literature

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great place to start based on their availability, relative expense, and relevance to a particular institution or health plan, as long as you are aware of the potential pitfalls

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internal data options (research)

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this methodology is especially useful for incorporating quality of life, patient preference, and satisfaction research

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patient surveys

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electronic medical records tracking of what? may help what? provides clearer picture of what? can incorporate data above and beyond what?

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allows tracking of data over time
may help overall quality of care in a practice
provides clearer picture of overall care
can incorporate data above and beyond the claim

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5 questions for selecting data source

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what is the question we are trying to answer?
what types of data are required?
what is the perspective we are evaluating?
are there data access considerations?
what resources are available for the study?

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disadvantages of electronic medical records: limited to what? data? challenges?

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limited to practice site collecting information
data consistency and completeness
accessibility challenges

Front 91

what are the phases of investigation? (6)

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1. ask the question
2. identification, measurement, and valuation of resources and outcomes
3. select a study design
4. collect data
5. analyze data
6. interpret and present results

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asking the question: define what? state what? identify what? establish what?

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define the problem as clearly as possible
state the objectives clearly and specifically
identify alternatives that are relevant and realistic
establish a framework based on priority of each study objective

Front 93

when identifying resources, defining the parameters up from helps what?

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frame data collection and analysis considerations

Front 94

in order to conduct an economic analysis, we must first carefully consider what?

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important resources that will be consumed by each alternative

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when identifying resources, you want to being prioritizing resource parameters based on these 2 things

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relative importance and magnitude
resources that can be quantified meaningfully

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this is the process of collecting units of resource required to produce the intended benefit for each alternative

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measuring resources

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one we identify and measure relevant resources, we want to assign what?

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economic value to them

Front 98

treatment outcomes should be measured in appropriate natural units, depending on what?

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type of outcome (ECHO)

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changes in outcomes attributable to an intervention should be valued based on what

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perspective

Front 100

what are the 3 categories of data sources for valuing outcomes

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economic
clinical
humanistic