Pharmacoeconomics outcomes

Naturalistic, retrospective database studies, which have set out specifically to investigate pharmacoeconomic outcomes, have included analyses of ... 

Several other examples of the value of pharmacokinetics services on patient or pharmacoeconomic outcomes are provided here. 

Clinical case reports of unusual treatments or response to therapy have presented a plethora of questions that remain to be answered. Case series and descriptions of experience with treatment protocols or the impact of pharmacist interventions are useful contributions to the literature. Evaluation of economics and outcomes has been an important area of research in critical care. The critically ill patient patient typically receives a large number of different and often expensive medications, and is monitored with expensive devices. Pharmacists have characterized various aspects of the cost of care, although comprehensive pharmacoeconomic outcome research is... 

Other institutional programs that typically involve pharmacists include pharmacoeconomics, outcomes research and management, quality improvement, and reimbursement assistance programs. 

There are many important variables to consider when attempting to document the overall costs of using a medication in a particular medical situation. Medication costs alone cannot begin to explain the true pharmacoeconomic outcome associated with the use of antiemetic drugs. For example, the costs associated with an unexpected hospital admission because of vomiting after an outpatient surgical procedure... 

Bakst A, Meletiche D, Arnold R, et al. The Avandia Worldwide Awareness Registry (AWARe ) an Internet-based program for evaluation of clinical, humanistic and economic outcomes of patients with type 2 diabetes. International Society for Pharmacoeconomics and Outcomes Research Sixth Annual International Meeting. Philadelphia, Pennsylvania, 2001. 

Lewis NJ, Patwell IT, Briesacher BA. The role of insurance claims databases in drug therapy outcomes research. Pharmacoeconomics 1993 4 323-30. 

The validity of pharmacoeconomic data is invariably diminished by two important factors a failure to account for all direct and indirect cost outcomes, and the difficulty of assigning costs to human experiences. In schizophrenia, validity is further reduced by the near-impossibility of conducting trials over several years, or even decades, so as to approach the reality of what is usually a lifelong illness. Given these observations, it would be imprudent to act on the minutiae of data generated in even the best-conducted trials, but it may well be appropriate to draw broad conclusions. 

Zotepine has been used in Japan and Germany for many years, but has only recently been marketed in the UK. Zotepine is referred to in two pharmacoeconomic publications (Byrom et al, 1998a, b), but no relevant data are provided. Two evaluations are apparently awaiting publication (Knoll, personal communication, 2001) one a 6-month comparison of zotepine and one a health-care model of outcomes associated with the use of zotepine and haloperidol. 

Hamilton SH, Revicki DA, Edgell ET, et al (1999). Clinical and economic outcomes of olanzapine compared with haloperidol for schizophrenia results from a randomised clinical trial. Pharmacoeconomics 15, 469—80. 

Pharmacoeconomic studies of other dmgs are fewer and, as with clozapine, rely on less robusr merhods. Risperidone is probably associared wirh lower costs. A Swedish study applying UK costs to patient outcomes showed a reduction in mean direct costs of about 7500 per patient per year (Guest et al, 1996). Other studies, however, show risperidone ro be cost-neutral (Revicki, 1999). There are fewer studies of olanzapine (although there are many publications), and taken together they suggest the dmg is at least cost-neutral with respect to immediate costs (Fichner et al, 1998 Hamilton et al, 1999). 

Pharmacoeconomics is the study of the costs and consequences of pharmaceutical products and services (Bootman et al., 1991). The basic question addressed in a pharmacoeconomic evaluation is not whether to use a particular product or service, but rather when and under what circumstances a particular intervention is efficient. Rather than focusing on just product cost, pharmacoeconomics examines the total economic impact of a pharmaceutical product on the health care system. The value of pharmaceuticals is determined by balancing the health system costs and consequences (outcomes) of its use. 

As noted by Goldsmith, medical technologies do not inherently increase health care costs. Their effects are broad-based and complex. Advances in medical technology may influence (1) the population at risk, (2) the cost of each treatment, (3) the risk of complications, (4) clinical incomes or hospital revenue, (5) the need for additional treatment, and/or (6) patients quality of life (Goldsmith, 1994). The pharmacoeconomics of an intervention are particularly important when the intervention is a therapeutic breakthrough (leads to better patient outcomes), is relatively expensive compared... 

Table 12.1 summarizes five major types of pharmacoeconomic evaluations cost-consequence, cost-benefit, cost-effectiveness, cost-minimization, and cost-utility (Drummond et al., 1997 Kielhorn and Graf von der Schulenburg, 2000). In a cost-consequence analysis, a comprehensive list of relevant costs and outcomes (consequences) of alternative therapeutic approaches are presented in tabular form. Costs and outcomes are typically organized according to their relationship to cost (direct and indirect), quality of life, patient preferences, and clinical outcomes (see taxonomy below). No attempt is made to combine the costs and outcomes into an economic ratio, and the interpretation of the analysis is left in large part to the reader. 

Kozma, C.M., et al., "Economic, Clinical, and Humanistic Outcomes A Planning Model for Pharmacoeconomic Research," Clin. Therapeut., 15, 1121-1132 (1993). 

Mullins, C.D., "Pharmacogenomics Methodological Considerations for Evaluating Outcomes and Cost-Effectiveness." Presented at the Ninth Annual Invitational Conference on Pharmacoeconomics. University of Arizona College of Pharmacy, Tucson, AZ, January 24, 2001. 

Therapeutic use (Phase III/IV) Refine understanding of benefit/risk relationship in general or special populations and/or environment Identity less common adverse reactions Refine dosing recommendation Comparative effectiveness studies Studies of mortality/morbidity outcomes Studies of additional endpoints Large simple trials Pharmacoeconomic studies... 

There is no doubt that the continuing evaluation of the safety of medicines into the post-marketing period is an expanding and stiU developing area of research. Matters relating to safety spread over into efficacy, which together imply risks and benefits which, in the present international climate of healthcare provision, have consequences for outcomes and costs. A whole new field of research - pharmacoeconomics - is in the process of development and it is to be anticipated that many of the methods used for safety evaluation will be modified and applied in this area. 

Because the principal focus of pharmacoeconomics is to incorporate outcomes in the demonstration of the value of a therapy, the quality of life that results from a therapy has received a great deal of attention in recent years. Most frequently, quality of life is measured using standardized instruments to collect patient-reported quality of life. These instruments are traditionally developed using patient or expert interviews to establish the areas of inquiry or domains of the instrument The use of these instruments in pharmacoeconomics is heavily dependent on the demonstrated psychometric properties of the instrument, such as its reliability, validity and responsiveness, or on sensitivity to the changes in the disease to be studied. 

Schumock G, BuderM. 2003. Evaluating and justifying clinical pharmacy services. In Grauer D, Lee J, Odom T, et al. (eds), Pharmacoeconomics and Outcomes Applications for Patient Care, 2ded. Kansas City, MO American College of Clinical Pharmacy. 

Kozma CM, Reeder CE, Schultz RM, 1993. Economic, clinical and humanistic outcomes A planning model for pharmacoeconomic research. Clin Ther 15 1121. 

Dr. Harrison is Assistant Professor of Pharmacy Administration at the University of Oklahoma Health Sciences Center College of Pharmacy. He received a B.S. in pharmacy from the University of Missouri—Kansas City. He received an M.S. in pharmacy and a Ph.D. in pharmaceutical sciences from the University of Arizona. Dr. Harrison has experience in many areas of pharmacy operations—retail, institutional, and research. Dr. Harrison teaches courses in research design, biostatistics, and pharmacoeconomics. Dr. Harrisons research interests are in the economic analyses of pharmaceutical services, outcomes research, and strategic planning by pharmacy institutions and businesses. 

International Society for Pharmacoeconomic and Outcomes Research (ISPOR)... 

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