Pharmacoeconomics & drug compliance


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pharmaco-economics and drug compliance

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Pharmacoeconomics & drug compliance

  2. 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 
  3. 3. 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
  4. 4. Pharmacoeconomics Relationship Pharmaceutical Care Consequences Cost
  6. 6. 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
  7. 7. 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
  9. 9. 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
  11. 11. 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) 
  12. 12. 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
  13. 13. COST EFFECTIVE PRESCRIBING Prescribing generic drugs  Adherence to evidence based medicine  Prescribing safest therapies  Prescribing the most cost effective options 
  14. 14. 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
  15. 15.  "Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein (1879-1955)
  16. 16. 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 
  17. 17. 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 
  18. 18. 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,
  19. 19. 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 
  20. 20. 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.
  21. 21. 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)
  22. 22. 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; 
  23. 23. 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 
  24. 24. 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 
  25. 25. 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       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.
  26. 26.  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.