General outline of pharmacoeconomics

1. vPHARMACOECONOMICS
IN
INDIA
COMPILED By: Sameer Shete

2. IINTRODUCTION:
HEALTHECONOMICS
PHARMACOECONOMICS
Cost andconsequences ofhealth care
interventions
Costand consequences ofPharmaceutical
services.

3. Why is it necessary ?
COST OF ILLNESS
BORROWING DEBTS
POVERTY

4. INDIAN SCENARIO
• No Significant Improvement.
• Sir Bhor Committee.
• Alma Ata Declaration
• Central Procurement Agency

5. ISPOR - INDIA
• Established in MAY 2006
• PE guidelines for India
• To benefit stakeholders

6. GUIDELINES
1. Identify target groups of audience and
type of analysis to be performed.
 Primary target : Ministry of health and family
welfare
 Secondary targets : Patients , prescribers ,
suppliers, hospitals, insurers and researchers.

7. 3. Justifications on choice of comparator
• Social perspective.
• Regardless of who incurs the cost or who
receives the benefit.
2. Identify perspective of the evaluation
• Right comparative treatment is important.
• Adhere to Indian situation.

8. 4. Choice on use of Analytical technique to be used
for PER
Analytical
techniques
COST
MINIMIZATION
ANALYSIS
COST
CONSEQUENCE
ANALYSIS
COST
EFFECTIVENESS
ANALYSIS
COST UTILITY
ANALYSIS
COST BENEFIT
ANALYSIS

9. Cost Minimization Analysis
• Only the costs of the alternatives need to be
compared.
• Important to consider what happens when
two drugs with similar efficacy and different
adverse effect profile.
• Omeprazole – Lansoprazole

10. Cost Benefit Analysis
• Willingness to pay method
• Least popular
• Exceed the actual cost of therapy

11. Cost Effectiveness Analysis
• Cost of the drug treatments are weighed against
the effectiveness of the drug.
• Cost of drug treatments :acquisition costs,
physician involvement, and nursing costs for
administration of the drug.
• Effectiveness of drug treatments: length of
hospital stay , duration of treatment , mortality
rate

12. Cost Utility Analysis
• Can combine more than one measure of
effectiveness or both measures of mortality
and morbidity into a single measure.
• Used when quality of life is the outcome of
interest when both morbidity and mortality
are important outcomes.

13. Cost Consequence Analysis
ADVANTAGES
Easily understood
Able to present the
border range of health
and non-health cost.
Alternative approaches
to measuring costs and
outcomes
DISADVANTAGES
No specific or
definitive guidance
Decisions may not
be transparent
Limited
Generalizability

14. 5. Time horizon of a Pharmacoeconomic
evaluation
• Capture all relevant outcomes.
• Assumptions should be explicit , well justified ,
And thoroughly tested by sensitivity analysis.

15. 6. Cost identification, measurement
and evaluation
• Direct costs within the healthcare system:
Medical costs of prevention, diagnosis, therapy.
• Direct costs outside the healthcare system:
Patient’s travelling expenses.
• Indirect costs within the healthcare system:
Medical costs which may arise during life years that
have been saved.
• Indirect costs outside the healthcare system:
Human capital approach , friction cost method.

16. 7. Assessing quality of life and QALYs
• Specific measures
• Generic measures
• Preference – based measures
• Wealth, freedom, political system, and
cleanliness of the environment all contribute
to the overall QOL.

17. 8. Modelling
• Effectiveness data from efficacy data.
• Data from other country.
• Ideally, Pharmacoeconomic studies should
report on drug effectiveness rather than
efficacy.

18. 9. Incremental analysis
• Differences between two alternatives.
• From the incremental analysis one can deduce
what the (net) difference in costs and effects
will be when the new treatment replaces the
existing one.

19. 10. Discounting future effects and costs
• If data on effects and costs are collected over a
period longer than one year, then the effects
and costs need to be discounted after the first
year.
• In the primary analysis the costs should be
discounted at a constant discount rate of 4%.
• Future effects should be discounted at a
constant discount rate of 1.5%.

20. APPLICATIONS

21. CASE STUDY - 1
 Management of Pain Resulting from Osteoarthritis
Treatment :
 NSAIDs
• effective pain relief
• 24 – 30% the cost of Cox-II inhibitors
• associated with a significant risk of adverse effects
 Dyspeptic symptoms
 More serious non-dyspeptic effects- symptomatic ulcers, ulcer
hemorrhage, ulcer perforation
 Cox- II inhibitors
• effective pain relief
• substantially more expensive than NSAIDs
• associated with lower risk of GI side effects
• of Pain Resulting from Osteoarthritis

22. • With no history of GI bleed, choose
naproxen
• With history of GI bleed, choose Cox-II
inhibitor
• Cox-II inhibitor ---Cardiovascular events

23. CASE STUDY - 2
• Treatment of Acute Deep Vein Thrombosis:
 Unfractionated heparin
• Effective for treating VTE
• Daily cost for IV therapy is low
• Requires close monitoring of clotting time/ dose titration
and, therefore, hospitalization
 Low molecular weight heparin
• Effective for treating VTE
• Daily cost for subcutaneous therapy is high
• Routine clotting time monitoring not required unless
obese or manifestations of renal compromise present
• Early discharge or outpatient treatment for VTE is possible