PHARMACOECONOMICS

1. PHARMACOECONOMICS
Presented by-
Dr. Aakanksha Priya,
Dept. of Pharmacology,
AIIMS, Patna.

2. OVERVIEW
• Introduction
• Definition of Pharmacoeconomics
• Methods of Pharmacoeconomics
• Cost effectiveness analysis
• Original article
• Conclusion
• Bibliography

3. INTRODUCTION
• Pharmacoeconomic research is the process of
identifying, measuring, and comparing the costs,
risks, and benefits of programs, services, or
therapies and determining which alternative
produces the best health outcome for the resource
invested.

4. DEFINITION
•Pharmacoeconomics has been
defined as the description and
analysis of the cost of drug
therapy to healthcare systems and
society.

5. METHODS OF
PHARMACOECONOMICS
PHARMACOECONOMICS
HUMANISTIC
1.Quality of life
2.Patient preferences
3.Patient satisfaction
ECONOMIC
1.Cost benefit analysis
2. Cost effectiveness analysis
3.Cost minimization analysis
4.Cost utility analysis

6. ECONOMIC BASIS OF
PHARMACOECONOMIC
COST BENEFIT ANALYSIS-
Cost-benefit analysis (CBA) is a method that allows for the
identification, measurement, and comparison of the benefits and costs
of a program or treatment alternative.
COST MINIMIZATION ANALYSIS-
Cost-minimization analysis (CMA) involves the determination of the
least costly alternative when comparing two or more treatment
alternatives.
COST UTILITY ANALYSIS-
Cost-utility analysis (CUA) is used to determine cost in terms of
utilities, especially quantity and quality of life.

7. COST EFFECTIVENESS
ANALYSIS
Cost-Effectiveness Analysis (CEA) estimates the costs
and health gains of alternative interventions.
It is expressed in the form of 2 different ratios-
1. Average cost-effectiveness ratio (ACER)- it represent
the total cost of a treatment alternative divided by
its clinical outcome to yield a ratio representing the
rupees cost per specific clinical outcome gained, which
are independent of comparators.
• ACER- health care cost(rs)/clinical outcome.

8. 2) Incremental Cost Effective Ratio(ICER)- It can be used to
determine the additional cost and effectiveness gained when
one treatment alternative is compared with the next best
treatment alternative.
• ICER- Cost of A(rs)- Cost of B (rs)/ effect of A(%) – effect of B(%)
• Thus, CEA can provide valuable data to support drug policy,
formulary management, and individual patient treatment
decisions.

9. ORIGINAL RESEARCH
ARTICLE
• TITLE- Pharmacoeconomic comparison of Losartan and
Amlodipine in patients of hypertension in a tertiary care
teaching hospital.
• STUDY CONDUCTED AT- Dept. of Pharmacology,
Rohilkhand Medical College and Hospital, Bareilly, U.P.
• BACKGROUND- To conduct a pharmacoeconomic
comparison (cost-effectiveness analysis) and to evaluate
the overall safety and efficacy of Losartan and
Amlodipine in reducing the Mean blood pressure per mm
Hg in hypertensive patients.

10. INTRODUCTION
• According to several studies, Losartan 50mg and
Amlodipine 5mg are equal in efficiency as anti-
hypertensive as monotherapy.
• Main objective – to study, cost per mmHg reduction of
Mean Blood Pressure and the cost per patients of
achieving BP control along with comparing the overall
efficacy and safety of the two antihypertensive agents.

11. METHODS
• It was a prospective, randomized, observational open
label comparative clinical study of three months duration.
• Inclusive criteria’s- 1)Patients of age 18-65 years 2) both
sexes 3) Newly diagnosed patients of hypertension were
enrolled.
• Written informed Consent were taken before start of the
study.
• Total of 80 patients were included who fulfilled all
inclusive criteria.

12. CONT….
 STEPS FOLLOWED –
• Demographic information were collected.
• Patient’s B.P was recorded by using mercury sphygmomanometer
and stethoscope.
• A total 80 patients were divided into 2 groups. One group was
treated with Losartan 50mg OD and other group received
Amlodipine 5 mg OD.
• Patients under treatment were subsequently monitored and re-
assessed at regular follow-ups for evaluation of BP reduction or
control and monitoring of adverse effects.

13. CONT…
• For pharmacoeconomic evaluation, cost effectiveness analysis was
done.
• Cost was expressed in term of currency in which it was bought.
• Effectiveness was taken as the average reduction in Mean BP and
the percent of patients reaching the goal value (<140/90) with fixed
dose schedule of antihypertensive in both the groups.
• The cost-effectiveness was calculated using incremental cost for per
mmHg BP reduction.
• ICER= Cost of A- Cost of B / Effect of A – Effect of B.

14. RESULTS (AT BASELINE)
LOSARTAN AMLODIPINE TOTAL
No. of patients 40 40 80
Male 22 24 46
Female 18 16 34
Rural 17 18 35
Urban 23 22 45
Age mean±SD
(years)
46.7±10.6 46.8±11.2
SBP, mean±SD
(mmHg)
154.86±6.86 154.64±5.12
DBP, mean±SD
(mmHg)
96.17±4.2 96.45±3.6
Mean, BMI
mean±SD (Kg/m²)
21.24±1.46 20.84±1.22

15. MEAN SBP BETWEEN 2 GROUPS
Mean BP±SD
LST
Mean BP±SD
AMLO
t- value df p- value
Baseline
154.86±6.86
Baseline±154.
64±5.12
0.1625 78 0.8713 not
significant
1st follow-up
149.34±5.24
1st follow-up
148.23±4.12
1.0532 78 0.2955 not
significant
2nd follow up
139.12±4.85
2nd follow up
140.68±4.12
1.0532 78 0.1788 not
significant
3rd follow up
131.96±4.82
3rd follow up
132.14±5.26
0.1596 78 0.8736 not
significant
P-value
<0.0001
P- value
<0.0001

16. MEAN DBP BETWEEN 2
GROUPS
(mean
BP±SD) LST
(Mean±SD)
Amlo
T- value df P-value
Baseline
96.17±4.2
Baseline
96.45±3.6
0.3201 78 0.7497
1st follow up
89.24± 3.12
1st follow up
90.28±2.12
1.7437 78 0.0851
2nd follow up
85.72±3.14
2nd follow up
86.68±2.42
1.5315 78 0.1297
3rd follow up
80.94±3.64
3re follow up
81.12±2.228
0.2651 78 0.7917
P-value
<0.0001
P-value
<0.0001

17. DIFFERENCE BETWEEN MEAN
BP(MBP) BETWEEN 2 REGIMEN.
GROUPS MBP±SD
BASELINE
MBP±SD
FINAL VISIT
MEAN
DIFFEREAN
CE±SD
P-VALUE
LST 115.73±3.84 97.94±4.16 17.79±0.32 0.4319
AMLO 115.84±3.96 98.12±4.42 17.72±0.46 0.4319

18. COST EFFECTIVENESS ANALYSIS OF
TWO REGIMEN BASED ON MBP
Drugs Total
cost(rs)=
Cost of 1
tab*no.of
days
consumed
Average
MBP(mmHg
)
%patients
who
achieved
target
BP(<140/90)
Cost/mmHg
MBP
reduction
Cost/target
BP
LST 1840(20*92) 17.79 80 103.42 23
AMLO 1012(11*92) 17.72 76 57.11 13.31

19. INCREMENTAL COST
EFFECTIVENESS RATIO
Paramet-
ers
LST AMLO Difference
in cost
Difference
in
effectivenes
s
ICER
Cost/mmH
g MBP
reduction
103.42 57.11 46.31 0.07 661.5
Average
fall in MBP
17.79 17.72

20. • Incremental Cost Effectiveness Ratio (ICER) value was
calculated to be Rs.661.5, which implies that in the
Losartan group to reduce the MBP by one mm Hg,
additional cost of Rs 661.5 has to be paid by the patient.
• It can therefore be assumed that in cases of stage1
Hypertension, it is exclusively the drug price rather than
the effectiveness/efficacy, which is more important
determinant of cost-effectiveness.

21. ADVERSE DRUG EFFECTS
Adverse effects (%) of patients LST
group
(%) of patients AMLO
group
Dizziness 3.5 1.2
Headache 1.5 0.9
Palpitation 1.0 2.2
G.I. upset 0.8 0.7
Cough 0.5 0
Emotional distress 1.0 0.8
Pedal oedema 0.6 10
Hot flushes 0.4 0.5

22. CONCLUSION
• Hence, the ICER indicated the most
favorable cost-effectiveness outcome for
Amlodipine with lower cost, effective
control of BP with acceptable tolerability.

23. BIBLIOGRAPHY
1) Shaifali I, singh HK. Pharmacoeconomics comparison of losartan
and amlodipine in patients of hypertension in a tertiary care teaching
hospital.IJBCP:2017;6(3):552-557.
2) TRASK, LISA SANCHEZ.. "Chapter 1. Pharmacoeconomics:
Principles, Methods, and Applications." Pharmacotherapy: A
Pathophysiologic Approach, 8e Eds. Joseph T. DiPiro, et al. New York,
NY: McGraw-Hill, 2011.
3)WHO