Pharmacoeconomics is a branch of health economics which compares the value of one drug or a drug therapy to another.
By understanding the principles, methods, and application of pharmacoeconomics, healthcare professionals will be prepared to make better decisions regarding the use of pharmaceutical products and services.
A concise overview of pharmacoeconomics, health economics, various costs, various pharmacoeconomic study designs and its application in the field of medicine and drug development
A concise overview of pharmacoeconomics, health economics, various costs, various pharmacoeconomic study designs and its application in the field of medicine and drug development
Introduction To Pharmacoeconomics, Objectives, Need of Pharmacoecomics, Four methods of Pharmaeconomics Evaluation, Basic Terminology, Importance of
Pharmacoeconomics.
Definition and scope of Pharmacoepidemiology ABUBAKRANSARI2
In these slides I shared the information of definition and scope of pharmacoepidemiology. Types of studies - cohort studies, cross-sectional studies etc.
Declaration: The materials incorporated in this document have come from variety of sources and compiler bears no responsibilities for any information contained herein. The compiler acknowledges all the sources although references have not been explicitly cited for all the contents in this document.
Quality Use of Medicines means:
• Selecting management options wisely by:
Considering the place of medicines in treating illness and maintaining health, and
recognising that there may be better ways than medicine to manage many disorders.
• Choosing suitable medicines if a medicine is considered necessary so that the best available option is selected by taking into account:
- the individual
- the clinical condition
- risks and benefits
- dosage and length of treatment
- any co-existing conditions
- other therapies
- monitoring considerations
- costs for the individual, the community and the health system as a whole.
Clinical pharmacokinetics and its application--
1)definition
2) APPLICATIONS OF CLINICAL PHARMACOKINETICS
Design of dosage regimens:
a) Nomograms and Tabulations in designing dosage regimen,
b) Conversion from intravenous to oral dosing,
c) Determination of dose and dosing intervals,
d) Drug dosing in the elderly and pediatrics and obese patients.
Pharmacokinetics of Drug Interaction:
a) Pharmacokinetic drug interactions
b) Inhibition and Induction of Drug metabolism
c) Inhibition of Biliary Excretion.
Therapeutic Drug monitoring:
a) Introduction
b) Individualization of drug dosage regimen (Variability – Genetic, Age and Weight, disease, Interacting drugs).
c) Indications for TDM. Protocol for TDM.
d) Pharmacokinetic/Pharmacodynamic Correlation in drug therapy.
e) TDM of drugs used in the following disease conditions: cardiovascular disease, Seizure disorders, Psychiatric conditions, and Organ transplantations
Dosage adjustment in Renal and Hepatic Disease.
a. Renal impairment
b. Pharmacokinetic considerations
c. General approach for dosage adjustment in renal disease.
d. Measurement of Glomerular Filtration rate and creatinine clearance.
e. Dosage adjustment for uremic patients.
f. Extracorporeal removal of drugs.
g. Effect of Hepatic disease on pharmacokinetics.
Population Pharmacokinetics.
a) Introduction to Bayesian Theory.
b) Adaptive method or Dosing with feedback.
c) Analysis of Population pharmacokinetic Data
Nomograms and tabulations in design of dosage regimens pavithra vinayak
Nomograms and tabulations in the design of dosage regimens --- NOMOGRAM IN UREMIC PATIENTS: NOMOGRAM FOR RELATIONSHIP BETWEEN CREATININE CLEARANCE AND ELIMINATION RATE CONSTANT FOR FOUR DRUGS clinical pharmacokinetics and therapeutic drug monitoring ---fifth PharmD notes
Introduction To Pharmacoeconomics, Objectives, Need of Pharmacoecomics, Four methods of Pharmaeconomics Evaluation, Basic Terminology, Importance of
Pharmacoeconomics.
Definition and scope of Pharmacoepidemiology ABUBAKRANSARI2
In these slides I shared the information of definition and scope of pharmacoepidemiology. Types of studies - cohort studies, cross-sectional studies etc.
Declaration: The materials incorporated in this document have come from variety of sources and compiler bears no responsibilities for any information contained herein. The compiler acknowledges all the sources although references have not been explicitly cited for all the contents in this document.
Quality Use of Medicines means:
• Selecting management options wisely by:
Considering the place of medicines in treating illness and maintaining health, and
recognising that there may be better ways than medicine to manage many disorders.
• Choosing suitable medicines if a medicine is considered necessary so that the best available option is selected by taking into account:
- the individual
- the clinical condition
- risks and benefits
- dosage and length of treatment
- any co-existing conditions
- other therapies
- monitoring considerations
- costs for the individual, the community and the health system as a whole.
Clinical pharmacokinetics and its application--
1)definition
2) APPLICATIONS OF CLINICAL PHARMACOKINETICS
Design of dosage regimens:
a) Nomograms and Tabulations in designing dosage regimen,
b) Conversion from intravenous to oral dosing,
c) Determination of dose and dosing intervals,
d) Drug dosing in the elderly and pediatrics and obese patients.
Pharmacokinetics of Drug Interaction:
a) Pharmacokinetic drug interactions
b) Inhibition and Induction of Drug metabolism
c) Inhibition of Biliary Excretion.
Therapeutic Drug monitoring:
a) Introduction
b) Individualization of drug dosage regimen (Variability – Genetic, Age and Weight, disease, Interacting drugs).
c) Indications for TDM. Protocol for TDM.
d) Pharmacokinetic/Pharmacodynamic Correlation in drug therapy.
e) TDM of drugs used in the following disease conditions: cardiovascular disease, Seizure disorders, Psychiatric conditions, and Organ transplantations
Dosage adjustment in Renal and Hepatic Disease.
a. Renal impairment
b. Pharmacokinetic considerations
c. General approach for dosage adjustment in renal disease.
d. Measurement of Glomerular Filtration rate and creatinine clearance.
e. Dosage adjustment for uremic patients.
f. Extracorporeal removal of drugs.
g. Effect of Hepatic disease on pharmacokinetics.
Population Pharmacokinetics.
a) Introduction to Bayesian Theory.
b) Adaptive method or Dosing with feedback.
c) Analysis of Population pharmacokinetic Data
Nomograms and tabulations in design of dosage regimens pavithra vinayak
Nomograms and tabulations in the design of dosage regimens --- NOMOGRAM IN UREMIC PATIENTS: NOMOGRAM FOR RELATIONSHIP BETWEEN CREATININE CLEARANCE AND ELIMINATION RATE CONSTANT FOR FOUR DRUGS clinical pharmacokinetics and therapeutic drug monitoring ---fifth PharmD notes
There is often more than one way of doing something in healthcare.
For
example, there may be two different drugs that can be used to treat
depres sion, or two surgical techniques for the management of dysmenorrhoea.
Note that interventions may be compared against each other ( for example
antibiotic A against antibiotic B) or against a ' do nothing' scenario.
There are different ways in which we can choose one of these options.
We may
decide to pick the more effective surgical technique, or we may decide to
select the less costly antidepressant. Economic evalu ation is a generic term for
techniques that are used to identify, measure and value both the costs and the
outcomes of healthcare interventions. An economic evaluation is concerned
with identifying the differences in costs and outcomes between options. It can
be defined as a study that compares the costs and benefits of two or more
alternative interventions; so, the main components are costs and benefits
Pharmacoeconomics is essential to reduce burden for patients in the terms of cost and improve the therapeutic effectiveness by selecting alternative treatments. Physician and pharmacist plays an important role in selecting drugs and treatment alternatives. So, proper selection helps to minimize the cost of therapy in patients. Research studies on pharmacoeconomics helps to know the burden of patients paying for their illness.
• Vorapoxar may interact with CYP3A4 enzyme inhibitors such as Ketoconazole, Itraconazole, Posaconazole, Clarithromycin, Nefazodone, Ritonavir, etc.
• Vorapoxar may also interact with CYP3A4 enzyme inducers like Rifampin.
• Cilostazol is a selective inhibitor of phosphodiesterase 3 (PDE3) and it is an antiplatelet drug and a vasodilator.
• Cilostazol can interact with Omeprazole, Fluoxetine, Fluvoxamine, Aspirin, Ticlopidine, Ticagrelor, Nefazodone, Azole antifungals, Idelalisib, Amiodarone, Cobicistat, Piperaquine and Ginkgo.
Glycoprotein IIB/IIIA inhibitors interact with Other Antiplatelets (Aspirin, Ticlopidine, Dipyridamole, etc.) and Ginkgo and increase the risk of bleeding.
Drug Interactions of Dipyridamole (Antiplatelt - Adenosine reuptake inhibitor)Naina Mohamed, PhD
Dipyridamole is used as an Antiplatelet drug by inhibiting the reuptake of adenosine. Dipyridamole can interact with many drugs including ADP blockers (Clopidogrel, Prasugrel, Ticlopidine, Ticagrelor, etc), Glycoprotein IIB/IIIA inhibitors (Abciximab, Tirofiban, etc.), Fibrinolytics (Reteplase, Tenecteplase, Streptokinase, etc.), Adenosine, Treprostinil, Sulfinpyrazone, Regadenoson, Distigmine and Ginkgo.
Drug Interactions of ADP receptor Blockers (Antiplatelets)Naina Mohamed, PhD
· ADP receptor Blockers (Antiplatelets) include Thienopyridines (Clopidogrel, Prasugrel, Ticlopidine) and Non-Thienopyridines (Ticagrelor, Cangrelor, Elinogrel ).
· The risk of adverse effects could be reduced by healthcare professionals through the screening, education, and follow up on suspected drug interactions.
Aspirin is an antiplatelet drug and it produces antiplatelet activity in lower doses (75-100 mg daily), while Higher dose of Aspirin (Up to 3600 mg daily in divided doses) is required for it’s analgesic effects.
§ Islamic fasting is similar to Alternate Day Fasting (ADF), since the feast and fast periods of Islamic fasting lasts 12 hours in average.
§ Though Islamic fasting is associated with some adverse effects, there was no detrimental effects on health attributed directly to them, in health individuals. And the adverse effects of fasting could be minimized very easily by following the preventive measures.
§ The chronic patients with Diabetes, Coronary Artery Disease (CAD), Cancer, Ulcer, Urolithiasis, Chronic Kidney Disease (CKD), etc. should consult the healthcare professionals before observing Fasting.
§ Moreover, Islam exempts the Sick, Travelers and Pregnant, Breast Feeding and Menstruating women from fasting.
§ Islamic Fasting can be good for health if it's done correctly.
Clinically Important Drug Interactions of FibrinolyticsNaina Mohamed, PhD
• It is Contraindicated to use Fibrinolytics and Defibrotide concomitantly.
• Drugs increasing the risk of Fibrinolytics associated Bleeding include…
o Anticoagulants (Warfarin, Heparin, Enoxaparin, Dabigatran, etc)
o Antiplatelet agents (Aspirin, Clopidogrel, etc)
o Pentosan Polysulfate Sodium
• Herbs increasing the risk of Fibrinolytics associated Bleeding include…
o Fenugreek
o Garlic
o Ginkgo
o Evening Primrose Oil
o Clove Oil
o Anise
o Turmeric (Curcumin)
o Licorice
o Asafetida
o Capsicum (Capsaicin)
o Celery
o Kava
o Cat's claw
o Medowsweet
o Feverfew
o Tan-shen
• It is Contraindicated to use Fibrinolytics and Defibrotide concomitantly.
• Drugs increasing the risk of Fibrinolytics associated Bleeding include…
o Anticoagulants (Warfarin, Heparin, Enoxaparin, Dabigatran, etc)
o Antiplatelet agents (Aspirin, Clopidogrel, etc)
o Pentosan Polysulfate Sodium
• Herbs increasing the risk of Fibrinolytics associated Bleeding include…
o Fenugreek
o Garlic
o Ginkgo
o Evening Primrose Oil
o Clove Oil
o Anise
o Turmeric (Curcumin)
o Licorice
o Asafetida
o Capsicum (Capsaicin)
o Celery
o Kava
o Cat's claw
o Medowsweet
o Feverfew
o Tan-shen
• Concurrent use of Streptokinase and Antiplatelet agents such as Aspirin, Dipyridamole and Clopidogrel results in elevated risk of Bleeding.
• It is Contraindicated to use Fibrinolytics and Defibrotide concomitantly.
• Drugs increasing the risk of Fibrinolytics associated Bleeding include…
o Anticoagulants (Warfarin, Heparin, Enoxaparin, Dabigatran, etc)
o Antiplatelet agents (Aspirin, Clopidogrel, etc)
o Pentosan Polysulfate Sodium
• Herbs increasing the risk of Fibrinolytics associated Bleeding include…
o Fenugreek
o Garlic
o Ginkgo
o Evening Primrose Oil
o Clove Oil
o Anise
o Turmeric (Curcumin)
o Licorice
o Asafetida
o Capsicum (Capsaicin)
o Celery
o Kava
o Cat's claw
o Medowsweet
o Feverfew
o Tan-shen
Drug Interactions of Recombinant Tissue Plasminogen Activators (rtPA)Naina Mohamed, PhD
Drug Interactions of Recombinant Tissue Plasminogen Activators (rtPA):
• The risk of Orolingual Angioedema is increased by the concomitant use of Alteplase and ACE inhibitors (Captopril, Lisinopril, Perindopril, etc).
• Concurrent use of Alteplase and Nitroglycerin (GTN) results in Less coronary artery reperfusion, Longer time to reperfusion, and more coronary artery Reocclusion
• It is Contraindicated to use Fibrinolytics and Defibrotide concomitantly.
• Drugs increasing the risk of Fibrinolytics associated Bleeding include…
o Anticoagulants (Warfarin, Heparin, Enoxaparin, Dabigatran, etc)
o Antiplatelet agents (Aspirin, Clopidogrel, etc)
o Pentosan Polysulfate Sodium
• Herbs increasing the risk of Fibrinolytics associated Bleeding include…
o Fenugreek
o Garlic
o Ginkgo
o Evening Primrose Oil
o Clove Oil
o Anise
o Turmeric (Curcumin)
o Licorice
o Asafetida
o Capsicum (Capsaicin)
o Celery
o Kava
o Cat's claw
o Medowsweet
o Feverfew
o Tan-shen
• Concomitant use of Dabigatran and Itraconazole or Ketoconazole is contraindicated.
• Drugs such as Heparin, Enoxaparin, Dalteparin, Tinzaparin, Bivalirudin, Lepirudin, Fondaparinux, Phenindione, Danaparoid, Rivaroxaban, Apixaban, Verapamil, Quinidine, Amiodarone, Ketoconazole, Itraconazole, Ritonavir, Saquinavir, Nelfinavir, Tacrolimus and Cyclosporine increase the risk of Dabigatran induced bleeding.
• Coadministration of Dabigatran with P-Glycoprotein Inducers like Carbamazepine, Rifampin or St. John's wort elevate the risk of Thrombosis.
Argatroban can interact majorly with drugs such as Heparin, Enoxaparin, Dalteparin, Tinzaparin, Bivalirudin, Lepirudin, Fondaparinux, Phenindione, Danaparoid, Rivaroxaban, Apixaban, and Dabigatran.
Hirudins such as Bivalirudin, Desirudin, Lepirudin can interact majorly with drugs such as Warfarin, Heparin, Enoxaparin, Dalteparin, Tinzaparin, Fondaparinux, Phenindione, Argatroban, Rivaroxaban, Apixaban and Dabigatran.
Danaparoid can interact majorly with drugs such as Warfarin, Hirudins (Bivalirudin, Lepirudin) and Other Anticoagulants like Heparin, Enoxaparin, Dalteparin, Tinzaparin, Fondaparinux, Phenindione, Argatroban, Rivaroxaban, Apixaban and Dabigatran.
Drug interactions of Low Molecular weight Heparins (LMWHs)Naina Mohamed, PhD
Low Molecular weight Heparins (LMWHs) may interact majorly with drugs such as Warfarin, Heparin and Other Anticoagulants like Danaparoid, Bivalirudin, Rivaroxaban, Apixaban, Dabigatran and Antiplatelet agents such as Aspirin, Clopidogrel, Ticagrelor, etc.
Concomitant use of Heparin and Telavancin or Oritavancin is contraindicated. Heparin may also interact majorly with other Anticoagulants such as Enoxaparin, Dalteparin, Bivalirudin, Danaparoid, Rivaroxaban, Apixaban and Dabigatran.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. Introduction
Health economics is the science of assessing cost and benefits of
healthcare.
Pharmacoeconomics is a branch of health economics which
compares the value of one drug or a drug therapy to another.
Pharmacoeconomics
Pharmakon -
Drug
Oikonomia -
Management of a
household
Oikos – House
Nomos – Law
3. Pharmacoeconomic Analysis
• Pharmacoeconomic analysis involves…
o Choosing a perspective
o Identifying and measuring costs
o Identifying and measuring consequences
4. Perspectives of Evaluation
Common perspectives include:
Patient perspective – Portion of cost not covered by
Insurance.
Provider perspective – eg. Hospitals- Direct costs
Payer perspective – eg. Insurance companies,
employers, or the government.
Society perspective - All direct and indirect costs.
5. Costs
The value of the resources consumed by a program or drug therapy, is defined
as Cost.
Healthcare costs are categorised as…
Direct Medical Costs - Drugs, medical supplies, and equipment, laboratory
and diagnostic tests, hospitalizations, and physician visits.
Direct Nonmedical Costs - Transportation to and from healthcare facilities,
extra trips to the emergency department, child or family care expenses, special
diets, and various other out-of-pocket expenses.
Indirect Nonmedical Costs - Morbidity cost – Loss of productivity. Mortality
– Loss of years of service due to premature death.
Intangible Costs - Nonfinancial outcomes of disease and medical care such as
pain, suffering, inconvenience, and grief.
Opportunity Costs – Value (economic benefit) of the alternative therapy that
was forgone.
Incremental Costs - The extra costs required to purchase an additional unit of
effect.
Direct Costs = Direct Medical Costs + Direct non-medical costs
Indirect Costs = Morbidity costs + Mortality costs
Total costs = Direct costs + Indirect costs + Intangible costs
6. Consequences (Outcomes)
Consequence is defined as the effects, outputs, or outcomes of the program or
drug therapy.
Consequences are categorised as…
Economic outcomes – Comparing direct, indirect, and intangible costs
with the consequences of medical treatment alternatives.
Clinical outcomes - Medical events that occur as a result of disease or
treatment (e.g., safety and efficacy end points).
Humanistic outcomes - Consequences of disease or treatment on patient
functional status such as physical function, social function, general health
and well-being, and life satisfaction.
Positive outcomes – Desired effect of a drug
Negative outcomes – ADR or toxicity of a drug
Intermediate outcome - Can serve as a proxy for more relevant final
outcomes
Final outcome – To get final outcome of reduced MI rate, lipid lowering
agents are being used to decrease LDL levels which is an intermediate
outcome.
7. Pharmacoeconomic Methodologies
Economic evaluations
Partial economic evaluations
o Cost consequence analysis (CCA) or Cost outcome analysis (COA)
o Cost-of-illness (COI) evaluation
Full economic evaluations
o Cost Minimization Analysis (CMA)
o Cost Benefit Analysis (CBA)
o Cost Effectiveness Analysis (CEA)
o Cost Utility Analysis (CUA)
Humanistic evaluation
Health Regulated Quality of Life (HRQOL)
Patient preferences
Patient satisfaction
8. Cost-Consequence Analysis (CCA)
Partial economic evaluations can
o Include simple descriptive tabulations of outcomes or
resources consumed
o Require a minimum of time and effort
A cost-outcome or cost-consequence analysis (CCA)
o describes the costs and consequences of an alternative
o does not provide a comparison with other treatment
options
9. Cost of Illness (COI) evaluation
COI identifies and estimates the overall cost of a
particular disease for a defined population.
COI evaluation method is also known as burden of
illness.
It involves measuring the direct and indirect costs
attributable to a specific disease such as diabetes,
mental disorders, or cancer.
COI evaluation is not used to compare competing
treatment alternatives but to provide an estimation of
the financial burden of a disease.
10. Cost Minimization Analysis (CMA)
Cost-minimization analysis is the most basic technique.
CMA involves the determination of the least costly
alternative.
For example, if drugs A and B are antiulcer agents
equivalent in efficacy and adverse drug reactions (ADRs),
then the costs of using these drugs could be compared
using CMA.
Another example would be prescribing a generic
preparation instead of the brand leader.
11. Cost Benefit Analysis (CBA)
Measures costs and benefits in monetary terms.
Estimates the strengths and weaknesses of alternatives.
Both the costs and the benefits are measured and converted into
equivalent dollars in the year in which they will occur.
The costs and benefits are expressed as a ratio (a benefit-to-cost (B:C)
ratio).
Many CBAs measure and quantify direct costs and direct benefits only
due to difficulties in measuring indirect and intangible benefits.
This approach is not widely used in health economics.
12. Cost Effectiveness Analysis (CEA)
The most commonly employed method is cost-effectiveness analysis.
Measures effectiveness (health benefit) in natural units (eg years of life saved, ulcers healed) and the
costs in money.
It compares therapies with qualitatively similar outcomes in a particular therapeutic area. For
instance, in severe reflux oesophagitis, using a proton pump inhibitor compared to using H2 blockers.
CEA does not allow comparisons to be made between two totally different areas of medicine with
different outcomes.
The results of CEA are expressed as a ratio either as an average cost-effectiveness ratio (ACER) or as an
incremental cost effectiveness ratio (ICER).
An ACER represents the total cost of a program or treatment alternative divided by its clinical
outcome to yield a ratio representing the dollar cost per specific clinical outcome gained,
independent of comparators.
Average cost effectiveness (ACER) = Net Cost / Net Health Benefit
The key measure of CEA is the incremental cost effectiveness ratio (ICER).
Incremental Cost Effectiveness Ratio = (Cost of drug A - Cost of drug B) / (Benefits of drug A - Benefits of drug B)
ICER = Difference in costs (A-B) / Difference in benefits (A-B)
• CEA is being used to set public policies regarding the use of pharmaceutical products (national
formularies) in countries such as Australia, New Zealand, and Canada.
14. COST EFFECTIVENESS GRID
Cost
effectiveness Lower cost Same cost
Higher
cost
Lower
effectiveness A B C
Same
effectiveness D E F
Higher
effectiveness G H I
are cost effective choices
are not cost effective
15. Cost Utility Analysis (CUA)
Cost-utility analysis (CUA) is a method for comparing treatment alternatives that
integrates patient preferences and Health Regulated Quality of Life (HRQOL) .
HRQOL measure is an utility, having value between 1.0 (perfect health) and 0.0 (death).
Quality-adjusted life years (QALYs) are then derived by multiplying the time in a health
state by the appropriate utility score.
In CUA, Cost is measured in dollars, and therapeutic outcome is measured in patient-weighted
utilities rather than in physical units.
This method is well suited to the evaluation of chronic diseases that have deleterious
effects on HRQOL.
Differences between treatments are expressed as the incremental cost per QALY gained.
CUA can compare cost, quality, and the quantity of patient-years.
Results of CUA are expressed in a ratio, a cost-utility ratio (C:U ratio).
CUA is complex, and thus CUA can be limited in scope of application from a
hospital or MCO perspective.
CUA is employed less frequently than other economic evaluation methods because
of a lack of agreement on measuring utilities, difficulty comparing QALYs across
patients and populations, and difficulty quantifying patient preferences.
In CEA, the costs are measured in money and there is a defined outcome. But in CUA,
the outcome is an unit of utility (e.g. a QALY).
16. Calculating QALYs (Example)
With treatment X Without treatment X
Estimated survival = 10 years Estimated survival = 5 years
Estimated quality of life Estimated quality of life
(relative to ‘perfect health’) = 0.7 (relative to ‘perfect health’) = 0.5
QALYs = (10 X 0.7) = 7.0 QALYs = (5 X 0.5) = 2.5
QALY gain from treatment X = 7 - 2.5 = 4.5 QALYs
If the cost of treatment X is £18,000 then the cost per QALY is £4,000 per QALY
(£18,000 divided between 4.5 additional QALY’s)
17. Humanistic Evaluation Methods
Methods for evaluating the impact of disease and
treatment of disease on a patient’s HRQOL, patient
preferences, and patient satisfaction are all growing in
popularity and application to pharmacotherapy decisions.
HRQOL has been defined as the assessment of the
functional effects of illness and its consequent therapy as
perceived by the patient.
These effects often are displayed as physical, emotional,
and social effects on the patient.
Measurement of HRQOL usually is achieved through the
use of patient-completed questionnaires.
18. Guidelines for performing a
Pharmacoeconomic analysis
A well-designed pharmacoeconomic analysis involves 10
steps:
Defining the problem
Determining the study's perspective
Determining the alternatives and outcomes
Selecting the appropriate pharmacoeconomic method
Placing monetary values on the outcomes
Identifying study resources
Establishing the probabilities of the outcomes
Applying decision analysis
Discounting costs or performing a sensitivity or incremental
cost analysis
Presenting the results, along with any limitations of the study.
19. Importance of
Pharmacoeconomics
Pharmacoeconomic analysis helps to achieve maximum
benefit in limited cost.
Clinicians want their patients to receive best care and
outcome available.
The payers want to manage rising costs.
Pharmacoeconomics combines the objectives of both
clinician and payers by estimating the value of patient
outcomes for the expenditure spent on medications and
other healthcare services.
In today’s healthcare settings, pharmacoeconomic methods
can be applied for effective formulary management,
individual patient treatment, medication policy
determination, and resource allocation.
20. Applications of
Pharmacoeconomics
Healthcare practitioners can benefit from applying the principles and methods of
pharmacoeconomics to their daily practice settings.
Pharmacoeconomics aid clinical and policy decision making.
Complete pharmacotherapy decisions should contain assessments of three basic
outcome areas whenever appropriate: economic, clinical, and humanistic outcomes
(ECHO).
Traditionally, most drug therapy decisions were based solely on the clinical outcomes
(e.g., safety and efficacy) associated with a treatment alternative.
Over the past 15 to 20 years, assessment of the economic outcomes associated with a
treatment alternative become popular.
The current trend is to incorporate the humanistic outcomes associated with a treatment
alternative, that is, to bring the patient back into this decision-making equation.
In today’s healthcare environment, it is no longer appropriate to make drug-selection
decisions based solely on acquisition costs.
Pharmacoeconomic data can be a powerful tool to support various clinical decisions,
including effective formulary management, individual patient treatment, medication
policy, and resource allocation.
21. Limits of Pharmacoeconomic
Evaluation
Health economics and pharmacoeconomics is a young science and is
slowly developing and testing its methodologies.
Many problems limit the use of health economics in practice.
The whole process may be open to bias, in the choice of comparator
drug, the assumptions made, or in the selective reporting of results.
Most studies are conducted or funded by pharmaceutical companies
who obviously are interested in the results, and there is a publication
bias towards those studies favourable to sponsoring companies.
Health economics is therefore sometimes misused as a marketing ploy.
Clinical pharmacologists should welcome pharmacoeconomic
evaluation as a means to promote efficiency and effectiveness of
prescribing.
22. Conclusions
Pharmacoeconomic research is used to identify, measure, and compare
the costs, risks, and benefits of programs, services, or therapies and
determine which alternative produces the best health outcome for the
resources invested.
Each pharmacoeconomic method measures costs in monetary terms;
the differences lie in the valuation of outcomes.
In CMA, the outcomes are considered to be equal and therefore are not
measured.
CBA measures outcomes in currency.
CEA measures outcomes in nonmonetary units.
In CUA, outcomes expressed in nonmonetary units are adjusted for
health-related quality of life (HRQOL).
By understanding the principles, methods, and application of
pharmacoeconomics, healthcare professionals will be prepared to
make better, more-informed decisions regarding the use of
pharmaceutical products and services.
23. References
Essentials of Pharmacoeconomics, 2nd edn
Karen L. Rascati
Understanding Health Outcomes and
Pharmacoeconomics
George E. Mackinnon
Pharmacoeconomics Principles and Practice, 1st edn
Lorenzo Pradelli , Albert wertheimer
Pharmacoeconomics from Theory to Practice, 2nd edn
Renee J.G. Arnold