Pharmacoeconomics of the health care intervention is equally important like the safety and efficacy of drug. The various strategies are available to incorporate pharmacoeconomics into pharmacotherapy. The most popular strategies for applying pharmacoeconomics to assess the value of pharmaceutical products and services include using the results of published pharmacoeconomic studies, building economic models, and conducting pharmacoeconomic research.

1. Strategies to incorporate
pharmacoeconomics into
pharmacotherapy
Presented by:
RAVI KUMAR YADAV (05/MPH/17)
M.Pharm Ist year Clinical Research
DIPSAR
Guided by :
Dr. S. K. gupta
HOD of Clinical Research,
DIPSAR

2. FLOW OF PRESENTATION
• Introduction
• Types of strategies
– Use published literatures
– Build an economic model
– Conduct a pharmacoeconomics study
• Conclusion
• References

3. INTRODUCTION
• Various strategies are available to incorporate pharmacoeconomics
into pharmacotherapy.
• Popular strategies for applying pharmacoeconomics to assess the
value of pharmaceutical products and services are as follows:
1. The results of published pharmacoeconomic studies.
2. Building economic models.
3. Conducting pharmacoeconomic research.

4. Types of strategies
STRATEGY ADVANTAGES DISADVANTAGES
1.USE PUBLISHED
LITERATURE.
2.BUILD AN ECONOMIC
MODEL
QUICK RESULT S FROM RCT
INEXPENSIVE DIFFICULT TO GENERALIZE
RESULTS.
SUBJECT TO PEER REVIEW MAY NOT BE
COMPARATIVE
MISUSE OF ITEMS
QUICK DEPEND ON ASSUMPTIONS
RELATIVELY INEXPENSIVE CONTROVERSIAL
YIELD ORGANISATION
SPECIFIC RESULTS
POTENTIAL FOR RESEARCH
BIAS
BRIDGES EFFICACY AND
EFFECTIVENESS

5. STRATEGY ADVANTAGES DISADVANTAGES
3.CONDUCT A
PHARMACOECONOMIC
STUDY.
FLEXIBLE EXPENSIVE
USUALLY COMPARATIVE TIME CONSUMING
YIELD ORGANISATION
SPECIFIC DATA.
DIFFICULT TO CONTROL
AND RANDOMIZE.
DATA FROM MULTIPLE
SOURCE CAN BE USED.
POTENTIAL FOR PATIENT
SELECTION BIAS,SMALL
SAMPLE SIZE.

6. 1. USE THE PHARMACOECONOMIC
LITERATURE
• Many pharmacoeconomic analyses are published in primary
medical and pharmacy literature sources.
• The eagerness to conduct pharmacoeconomic evaluations of
drugs often exceeds the quality of these evaluations.
• To use this literature as an aid in clinical decision making, it
must be
(1) critically evaluated for quality and rigor and
(2) interpreted correctly.

7. • To enhance the ability to use pharmacoeconomic results
published in the literature, consider the following points:
– What is the technical merit of the study?
– Are the results applicable to local decision making?
– Do the results apply generally in different jurisdictions with different
perspectives?
• Various guidelines, criteria, reviews, and consensus-based
recommendations for evaluating, conducting, and reporting
pharmacoeconomic literature have been published.
•
•
•

8. Basic Criteria for Evaluation of
Pharmacoeconomic Literature
Objective
• What is the question(s) being considered?
• Is the question clear, defined, and measurable?
Perspective
• What is/are the perspective(s) of the analysis?
• Is the perspective appropriate given the scope of the problem?
Pharmacoeconomic method
• What pharmacoeconomic tool was used?
• Is it appropriate given the problem?
• Is it actually what was conducted?
Study design
• What was the study design?
• What were the data sources?
• Is the evaluation suitable if carried out in a clinical trial?

9. Costs and consequences
• What are the costs and consequences (outcomes) included?
• Are the costs and outcomes relevant to the perspective chosen?
• Do they include negative outcomes (failures, ADRs)?
• How were they valued?
• Were costs and consequences measured in the appropriate physical
units?
Discounting
• Was the study performed over time?
• Were costs and consequences that occur in the future discounted to their
present value?
• Was any justification given for the discount rate used?
Results
• Are the results accurate and practical for medical decision makers?
• Were the appropriate statistical analyses performed?
• Was an incremental cost analysis performed?

10. Sensitivity analysis
• Are the cost ranges for significant variables tested for
sensitivity?
• Are the appropriate and relevant variables varied?
• Do the findings follow the anticipated trend?
Conclusions
• Are the conclusions of the study justified?
• Is it possible to extrapolate the conclusions to daily clinical
practice?
Sponsorship
• Was there any bias due to the sponsorship of the study?

11. 2. BUILD AN ECONOMIC MODEL
• Studies that model the economic impact of a
pharmaceutical product or service on a defined
population are increasing in popularity.
• Modeling studies use existing clinical and/or
epidemiologic data to project future outcomes.
• Pharmacoeconomic models are often broadly
defined to include:
1.Decision analysis
2.Markov models
3.Multivariate regression analysis
4.Basic spreadsheet analyses.

12. CLINICAL DECISION ANALYSIS
• Decision analysis is a tool that allow users to apply Evidence
based medicine to make informed and objective clinical
decisions when faced with complex situations.
• A decision tree ,together with literature derived probability and
defined outcome value is used to model a given problem.
• Many examples of decision-analytic models are available in the
literature, spanning many therapeutic areas, including the
treatment of depression, migraine, type 2 diabetes, and
community-acquired pneumonia (CAP).

13. MARKOV MODELS
• Markov models is another method of decision analysis that
provides an alternative way to arrange the decision process so
that clinical outcomes and time-dependent risk changes are
managed efficiently.
• The Markov model is designed to simulate the most important
aspects of a disease and can be used to estimate the long-term
clinical, humanistic, and economic dimensions of the disease.
• There are examples of markov models available in tha literature,
including estimates of the cost - effectiveness of interferon alpha
therapy for the treatment of chronic hepatitis - C infection.

14. Multivariate regression analysis
• Multivariate regression is a technique that estimates a single
regression model with more than one outcome variable.
• When there is more than one predictor variable in a
multivariate regression model, the model is a multivariate
multiple regression.
• Example . A doctor has collected data on cholesterol, blood
pressure, and weight. She also collected data on the eating
habits of the subjects (e.g., how many ounces of red meat, fish,
dairy products, and chocolate consumed per week). She wants
to investigate the relationship between the three measures of
health and eating habits.

15. Conduct a Pharmacoeconomic
Evaluation
• Clinicians may need to conduct a pharmacoeconomic
evaluation
1. if there is insufficient literature,
2. if published results cannot be extrapolated to
clinical practice,
3. or if building a model is not appropriate.
• The resources necessary and the type of evaluation
conducted will vary depending on the research
question and on whether one is conducting a
prospective outcomes analysis or a retrospective
database analysis.

16. Advantages and Disadvantages of Retrospective
and Prospective Analyses
ANALYSIS TYPE ADVANTAGES DISADVANTAGES
1.PROSPECTIVE
OBSERVATIONAL ANALYSIS
FLEXIBLE EXPENSIVE(TIME&MONEY)
OFFER COMPARATIVE DATA DIFFICULT TO CONTROL
AND RANDOMIZE.
DATA FROM MULTIPLE
SOURCE CAN BE USED.
SMALL SAMPLE SIZE.
LESS EXPENSIVE THAN
RANDOMIZED CONTROL
TRIALS.
PATIENT SELECTION BIAS.
2.RETROSPECTIVE
DATABASE ANALYSIS
LARGE SAMPLE SIZE INCOSISTENT
CODING/UPCODING
CAN PROVIDE DATA
QUICKLY
VARIATION IN DATABASE
QUALITY.
INEXPENSIVE INABLE TO RANDOMIZE.

17. STEPS FOR CONDUCTING A
PHARMACOECONOMIC EVALUATION
1. Define the Pharmacoeconomic Problem.
2. Assemble a Cross-Functional Study Team.
3. Define the Appropriate Study Perspective.
4. Identify Treatment Alternatives and Outcomes.
5. Identify the Appropriate Pharmacoeconomic
Method to Employ.
6. Place a Monetary Value on Treatment
Alternatives and Outcomes.
7. Identify Resources to Conduct Study in an
Efficient Manner.

18. 8.Identify Probabilities that Outcomes May Occur
in the Study Population
9. Employ Decision Analysis
10. Discount Costs or Perform a Sensitivity or
Incremental Cost Analysis
11. Present Study Results
12. Develop a Policy or an Intervention
13. Implement Policy and Educate Professionals
14. Follow-Up Documentation

19. Conclusions
• The principles and methods
of pharmacoeconomics provide the means to
quantify the value of pharmacotherapy through
balancing costs and outcomes.
• 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—that is,
decisions that ultimately represent the best
interests of the patient, the healthcare system, and
society.

20. REFERENCES
• Joseph T. diPiro. Pharmacotherapy : A
Pathophysiologic approach, 8th edition, McGraw - Hill
medical.
• McGhan WF, Rowland CR, Bootman JL. Cost-benefit
and cost-effectiveness: Methodologies for evaluating
innovative pharmaceutical services. Am J Hosp Pharm
1978;35:133–140.
• https://accesspharmacy.mhmedical.com