Drugs cost-utility’ analysis

Establishing the value of a new pharmaceutical can be done through a cost-effectiveness ratio, where the costs are compared with currently accepted therapy and the effect is expressed in natural units such as life-years gained or disability-free days. A cost-utility analysis uses QALYs as the expression of the drug s effect, which is a measure that incorporates all the outcomes as well as all the costs of the drug treatment. Such a broad-based measure captures how much improved the patient s life becomes as a result of the treatment and at what cost. Quality-adjusted life-years can be viewed as life-years gained,... 

Cost-utility analysis is concerned with comparisons between programmes, e.g. an antenatal drug treatment which saves a young life or a hip replacement operation which improves mobility in a man of 60 years. Such differing outcomes can be placed on the same basis for comparison by computing quality-adjusted life years (see below). 

Gabriel SE, Campion ME, O Fallon WM. A cost-utility analysis of misoprostol prophylaxis forrheumatoid arthritis patients receiving nonsteroidal anti-inllanunatory drugs. Arthritis Rheum 1994 37 333-341. 

Column size is another important consideration. For equipment designed for most routine laboratory HPLC situations the relative sensitivity of APTelectrospray instruments is better at low flow rates (0.2-0.8 mL/min) whereas the relative sensitivity of APCI instruments is enhanced at high flow rates (0.5-2 mL/min). As a result, small columns are appropriate for API-electrospray/MS and, if only one or two compounds of interest are found in a particular sample, high-resolution separations are not necessary. For APTelectrospray analysis of complex samples, 150 mm x 4.1 mml.D., 3 pm columns (flow 0.5-1.0 mL/min) are usually sufficient. For drug quantification involving analysis of single or low numbers of compounds, small columns such as 30 mm x 2.1 mm I.D., 3.5 pm columns (flow rate 0.2-0.4 mL/min) provide sufficient separation and a saving in both column cost and solvent utilization. The reduced injection volume required for the small columns often results in better resolution and increased sensitivity. 

Nowadays a drug company has not only to show its paymasters - governments, insurers and so on - that its new prodnct is safe and works, but also that it is cost-effective. In Anstralia, this has been spelled out in legislation. Since 1993, any drng submitted for approval must be accompanied not only by the resnlts of clinical trials bnt also by an economic impact analysis. In 1999, the United Kingdom set np a National Institnte for Clinical Excellence (NICE) to advise the National Health Service on the cost-effectiveness of health care technologies. Other countries ask formally or informally for pharmacoeconomic analysis. Economic impacts can be measured in a variety of ways, for example, cost-effectiveness, cost-utility or full cost-benefit stndies. 

In general, the use of Bayesian network meta-analysis has broad applicability to evaluate AEs between related drugs. These methods can provide insight to prescribers and also assess cost-effectiveness. The direct probability statements that result from the Bayesian approach are helpful to decision makers evaluating a variety of medical products for a given therapeutic area/indication. Furthermore, the information obtained from the network meta-analysis can be utilized throughout the medical product development life cycle in simulations to design future clinical trials. 

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