pharmaco-economics and drug compliance

1. PHARMACOECONOMICS & DRUG
COMPLIANCE
Dr Naser Ashraf Tadvi

2. OBJECTIVES
Explain pharmaco-economics & prescription cost
 Evaluate the cost-effective drug therapy
 Discuss the significance of pharmaco-economics in
various strata of society
 Explain drug compliance, adherence and
therapeutic failure
 Discuss consequences of non compliance


5. PHARMACO-ECONOMICS

Description and analysis of the costs and
consequences of pharmaceutical products and
services and their impact on individuals, health care
system and society

6. Pharmacoeconomics
Relationship
Pharmaceutical Care
Consequences
Cost

7. CONSEQUENCES

8. PHARMACO-ECONOMIC METHODS
Clinical
Economic
Humanistic
• Efficacy
• Safety
• Impact of therapy
on “natural history”
of the disease
• Cost consequence Analysis
• Cost-of-Illness
• Cost-Minimization
• Cost-Benefit
• Cost-Effectiveness
• Health Related
Quality of Life
• Patient Satisfaction
• Caregiver Impact
• Patient Preferences
• Functional Status

9. COST CONSEQUENCE ANALYSIS

All the relevant costs and outcomes of drug therapy or
healthcare intervention like direct medical costs, direct
nonmedical costs, indirect costs , clinical costs etc are
analyzed

For Example : Drugs used in stroke prevention include
drug cost, hospital cost , other costs and include special
monitoring , number of strokes observed , number of
deaths observed, the rate of side effect

10. PRESCRIPTION/INVESTIGATIONS/OTHERS COST

11. PHARMACOECONOMIC METHODOLOGIES
Method
Description
Application
Cost of Illness
Estimates cost of
disease on a defined
population
Used to provide
baseline to compare
prevention and
treatment options
against
Cost Minimization
Finds the least
expensive cost
alternative
Use when benefits are
same
Cost Benefit
Measures benefit in
monetary units and
computes net gain
For decision makers
can compare
programmes with
different objectives
Cost effectiveness
Compares alternatives
with therapeutic effects
measured in physical
units

12. COST BENEFIT ANALYSIS

13. COST EFFECTIVENESS ANALYSIS
Cost effectiveness of any therapeutic intervention
may be expressed in terms of natural units such as
Life Years Gained (LYG) or infection avoided.
 It may also be expressed in utility terms like Quality
of Life (Quality adjusted Life years)


14. VALUE FOR MONEY : COST VERSUS BENEFIT
Cost
Benefit
Drug costs
+
 Out patient visits
+
 Inpatient costs


More symptom free
days
 Less hospital
admissions
 Increased quality of life
 Increased survival

15. COST EFFECTIVE PRESCRIBING
Prescribing generic drugs
 Adherence to evidence based medicine
 Prescribing safest therapies
 Prescribing the most cost effective options


16. SIGNIFICANCE OF PHARMACO-ECONOMICS








Drug therapy evaluation
Selecting the most cost-effective drugs for hospital formulary
Making a decision about individual patients therapy
Determining value of existing service
Helps government agencies in pricing, approval, formularies
and policy making
For patient: cost can be reduced and better treatment
Society : decrease in morbidity and mortality
Provider: marketing, pricing and performance guarantee

23. 
"Not everything that can be counted counts, and not
everything that counts can be counted."
- Albert Einstein (1879-1955)

24. COMPLIANCE
The extent to which a person‟s behaviour
(in terms of taking medications, following diets or
executing lifestyle changes) coincides with medical
or health advice
 More authoritative term

Doctor dictates
 Patient follow`s or doesn‟t follow


May be
Partial
 Total
 Overcompliance


25. ADHERENCE
„The extent to which a person‟s behaviour – taking
medication, following a diet and/or executing
lifestyle changes – corresponds with agreed
recommendations from a healthcare provider‟
 Implies active role of patient in collaboration with
prescriber
 Self motivated decision to adhere to treatment or
advice
 Self regulation of illness and treatment


26. NON ADHERENCE / NON COMPLIANCE
Delays in seeking medical care
 Failure to keep appointments
 Failure to follow intructions






Correct frequency of dosing
Correct timing of dosing
Correct administration of dosing
Correct intensity of dosing
Underuse, overuse,

27. HOW BIG IS THE PROBLEM?
Medicines cannot be effective if
patients do not use them
 There are varying estimates on the
size of the problem:

Between 33% and 50% of medicines for
chronic diseases are not used as
recommended
 20-30% don‟t adhere to regimens that are
curative or relieve symptoms
 30-40% fail to follow regimens designed
to prevent health problems


28. THE CHALLENGE

It is often a hidden problem
undisclosed by patients
 unrecognised by prescribers


It has been suggested that
increasing the effectiveness of
adherence interventions may have
a far greater impact on the health of
the population than any
improvement in specific medical
treatments
Haynes R, McDonald H, Garg A, Montague P. (2002). Interventions for helping patients to follow prescriptions for
medications. The Cochrane Database of Systematic Reviews, 2, CD000011.

29. WHY DON‟T SOME PEOPLE USE THEIR MEDICINES
AS PRESCRIBED?
1) They don‟t want to
(intentional non-adherence)
2) They have practical problems
(unintentional non-adherence)

30. EXAMPLES OF UNINTENTIONAL NON
ADHERENCE
A 62-year-old man requiring a metered-dose inhaler
(for the first time) was told to 'spray the medicine to
the throat'.
 He was found to have been conscientiously aiming
and firing the aerosol to his anterior neck around
the thyroid cartilage, four times a day for two weeks
(Chiang A A, Lee JC 1994 New England Journal of
Medicine 330:1690).
 A patient thought that 'sublingual' meant able to
speak two languages;


31. CONSEQUENCES OF NON COMPLIANCE
Therapeutic drug failure
 Potential harm resulting from sub-optimal
management
 Sometimes increased clinical risk due to additional
prescribing
 Cost of medicines dispensed but not used
 Poorly managed chronic diseases can reduce the
economic contribution individuals can make to
society


32. COMMON INTERVENTIONS TO IMPROVE
COMPLIANCE
Educating patient on the medicine to
increase their knowledge
 Simplifying the regimen
 Making it easier to remember to use
the medicine (physical aids and
reminders)
 Direct observed Treatment


33. WHAT EVERY PATIENT SHOULD KNOW



An account of the disease and the reason for
prescribing
The name of the medicine
The objective
to treat the disease and/or
 to relieve symptoms, i.e. how important the Medicine is,
whether the patient can judge its efficacy and when benefit
can be expected to occur





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How and when to take the medicine
Whether it matters if a dose is missed and what, if
anything, to do about it
How long the medicine is likely to be needed
How to recognise adverse effects and any action that
should be taken, including effects on car driving
Any interaction with alcohol or other medicines.

34. 
Doctors may smile at the ignorant naivety of
patients, but the smile should be replaced by a
blush of shame at their own deficiencies as
communicators.