COMPREHENSIVE LECTURE

SOCIAL AND ADMINISTRATION PHARMACY

(SAP)
HOSPITAL PHARMACY
 FIFO
.
.
. lot
. lot

a.
b.
c.
d.
e.
 DOTS (Directly Observed Treatment, Short Course)
a.
b.
c.
d.
e.
 drug use
evaluation statin
1.
2.
3.
4.
5.
 paracetamol syrup 1 ( 360 mg) 25

1. Wrong drug
2. Subtherapeutic
3. Overdosage
4. ADR
5. Invalid indication
 PTU

1.
2.
3.
4.
5.


.
.














(Drug Utilization Evaluation, DUE)

1)


2)
3
()

naproxen .
1.
2. 2
3.
4.

5.
 sodium bicarbonate
injection
1.
2. GPO 50000
3. GPO
4. 50000
5. GPO
Norfloxacin 2551
1.
2.
3.
4.
5.
 sucrafate
1.
2.

3.

4.

5.

 .. 2555
a.
b.
c.
d. Isafe score
e.



100,000

100,000 2,000,000

2,000,000


100,000






20

(1)


(2)

Note GPO
 cefazolin inj

1. 1
2.
3. 1
4. 1
5.
 Praziquantal

. 1
. 1
. 1
.
.
RESEARCH METHODOLOGY

a.
b.
c.
d.
e.
 placebo
1-100 0= 100=
normal distribution
1. Mann-whitney U test
2. pair t-test
3. Wilcoxon
4. cox propotional hazard model
5. ANOVA
 RESEARCH METHODOLOGY

Science research

Social Science research

Quantitative research

Qualitative research
 RESEARCH METHODOLOGY

Survey research

Former research

Experimental research
 Data

Statistical data
Qualitative data

Qualitative data

Time series

Scale of measurement
Nominal

Ordinal

Interval

Ratio

29

/




30








Parametric
statistics


Non-parametric
statistics

31


(Population)

(Sample)

 ( )

(Parameter)

(Statistic)


35

2
1. (Descriptive Statistics)
2. (Inferential Statistics)
 (Descriptive Statistics)

 (Inference Statistics)





(Estimation) (Hypothesis testing)
T-test, F-test ,(Chi-square)

38

: t-test, F-test, chi-square test

:
(correlation analysis) Pearson
correlation, Spearman rank correlation, chi-square, simple regression,
multiple regression

2 independent grs. Nominal40 Chi-Square
Fishers exact
Ordinal Mann Whitney U
Scale t-test

2 related grs. Nominal McNemar Chi-Square

(matched grs, before/after, Sign test,
cross over) Ordinal Wilcoxon signed rank
Scale Paired t-test
>2 grs. Independent grs. Nominal Chi-Square
Ordinal Kruskal Wallis
Scale ANOVA

>2 grs. related grs. Nominal Cochran Q

(matched grs, before/after, Ordinal Friedman
cross over) Scale ANOVA repeated


Nominal Non-parameter Chi square

Non-parameter
Ordinal Mann Whitney U
spearman, Chi square

Parameter:
Interval t-test (2), one-way anova (3)
pearson, regression


Parameter :
Ratio t-test (2) one-way anova (3)
pearson, regression
Correlation statistics
1.) (Perfect correlation)
- (Perfect positive correlation)
1
- (Perfect negative correlation)
-1
2.) (Imperfect correlation)
- (Imperfect positive correlation)
0 1
- (Imperfect negative correlation)
0 -1
3.) (Zero correlation)
- 0

0.81-1.00
0.61-0.80
0.41-0.60
0.21-0.40
0.01-0.20


(Pearson Correlation Coefficient)

(Interval Scale) (Ratio)

(Spearman Correlation Coefficient)

ordinal

2
Pharmacoepidemiology
 X

a. Cohort study
b. Case-control study
c. Randomized control tried
d. Semi Qualitative Research
e. Qualitative research

D
D

. Case control
. Randomized control study
. Case report
. Analysis of secular trend

case 1,000 case

1.Randomized double blind controlled trial

2.Case-control
3.Cohort
4.Retrospective study
5.Quasi-experimental
A B

1. randomize control trial
2. case control
3. cohort study
4. case report
5. expert opinion
13. (Post-marketing
control)
a.
b.
c.
d.
 (epidemiologic study)

1. Descriptive studies 2. Analytical studies 3. Integrative or

1.1 Individuals 2.1 Observational Synthetically research
- Case report studies - Systematic review
- Case series - Case control studies - Meta-analysis
1.2 Cross-sectional - Cohort studies - Economic analysis
surveys 2.2 Intervention studies
(Experimental studies)
- clinical research
 (Retrospective) Case-control study
52

risk
Case
risk

risk

Control
risk

 (Prospective) Cohort study
53

A
Cohort B

C

D
 OR,RR

Case A B A+B
Control C D C+D
A+C B+D A+B+C+D

Odd ratio = AD/BC

Relative risk = A/(A+B)
C/(C+D)
 Randomized controlled trial
55

Treatment outcome
A

Sample random

Treatment outcome
B

Epidemiologic risk assessment
56

Relative Risk (RR) Odds Ratio (OR)

(RR) = 9
9

= 1; equal relationship

>1; causing disease

<1; prevention

Epidemiologic risk assessment
57

95% CI

95% CI 1
95% CI > 1
95% CI < 1

58

(Relative Risk range)
0.0 0.3
0.4 0.5
0.6 0.8
0.9 1.1
1.2 1.6
1.7 2.5
> 2.6

59

MI
4 (95% CI 2.34 7.76)
: MI 4

A MI RR 0.36 (0.13-0.65)
: A MI 0.36

MI 2.7
OR
1.2 (95% CI 0.73 3.37)
:
1.2


Epidemiologic risk assessment
60

Relative Risk (RR) Odds Ratio (OR)

Relative Risk Reduction (RRR)


A 60% B 40%
RRR = (60% - 40%)/40% = 50 %
: A 50 %
B

Epidemiologic risk assessment 61

Absolute Risk Reduction (ARR)

A
60% B 40%
ARR = 60% - 40% = 20% 0.2
: A 20%
Number Needed to Treat (NNT)

1
NNT = 1/ARR
NNT 1/0.2 = 5
: A 5
1


Epidemiologic risk assessment 62

Number needed to harm (NNH)

1
NNH = 5

:
A 5
1

Pharmacoeconomics


a. Cost minimization analysis

b. Cost effectiveness analysis
c. Cost benefit analysis
d. Cost utility analysis
e. Cost outcome Description

1. Direct medical cost
2. Direct non-medical cost
3. Indirect cost
4. Intangible cost
5.
 Utility
1. Cost 25,000 Utility 0.5
2. Cost 50,000 Utility 0.5
3. Cost 55,000 Utility 0.6
4. Cost 77,000 Utility 0.5
5. Cost 88,000 Utility 0.8
86. 2 A B

utility
A 1,500,000 0.75
B 1,200,000 0.7
1. A
2. B
3. A utility
4. B
5.

Health care Health
Cost
intervention improvement

Cost Health
Value
identification effect

Benefit Utility Cost-

Cost Money unit QALY effectiveness
minimization
Cost-
Cost-utility
benefit

: , 2543


CMA
CEA - ,
- ,
CBA

CUA - -
- -

Cost-minimization analysis : CMA

(Identical benefits)



Cost-minimization analysis : CMA
Cost factor Drug A Drug B
425 490
150 150
190 120
ADR 175 125
940 885

Cost-effectiveness analysis: CEA

(Natural
units of measurement)
(health outcome)
(clinical outcome)





Cost-effectiveness analysis: CEA

(disability adjusted life year : DALYs)
(YLLs)
(YLDs)

Cost-effectiveness analysis: CEA
(
)


Cost-effectiveness analysis: CEA
Cost factor Drug A Drug B
425 490
150 150
190 120
ADR 175 125
940 885
2 1
Cost effectiveness ratio 940/2 885/1
Cost per life year save 470 885

Cost-benefit analysis: CBA

(economic outcome)
(Monetary terms)
CEA 2
benefit-cost ratio (> 1 )
2 (
/)
Cost-benefit analysis: CBA
Cost factor Drug A Drug B
625 700
75 0
150 150
ADR 125 125
975 975
.. 0 3,500
1,950 4,300
benefit cost ratio 2:1 8:1
(1950/975) (7,800/975)

Cost-utility analysis: CUA

(humanity outcome) (Utility)
(Well-being)

(Quality-adjusted Life Year: QALY)
( )
QALY


Cost-utility analysis: CUA

Rating scales
Time trade-off
Standard gamble

Cost-utility analysis: CUA
Rating scales
10 point rating scale ( 0-10 )
The visual analogue method

0 100


Cost-utility analysis: CUA
Time trade-off ()
2
1
10%
10

Cost-utility analysis: CUA
Standard gamble ( )





Cost-utility analysis: CUA
Standard gamble

Choice A Remain

disease Go to
Cure
wellness
Choice B
Death
Cost-utility analysis: CUA
Cost factor Drug A Drug B
800 940
75 0
190 190
ADR 80 0
1,070 1,130
Utility factor
QOL index (0-10) 6.6 9
Cost utility ratio 162:1 125:1
(1,070/6.6) (1,130/9)

Health care Health
Cost
intervention improvement

Cost Health
Value
identification effect

Benefit Utility Cost-

Cost Money unit QALY effectiveness
minimization
Cost-
Cost-utility
benefit

: , 2543


CMA
CEA - ,
- ,
CBA

CUA - -
- -


CUA > CBA >CEA >CMA
CUA : : bias
CBA : : bias
CEA
Patent & CL

a.
b.
c.
d.
e.
68.

1. 2.
3. 4.
5.
Public health


. (.)
. (.)
. (.)
. (.)
. (.)

.
.

. .
.
.

1.
2.
3.
4.

1) celecoxib
2) glucosamine
3) colchicine
4) diclofenac
5) prednisolone


96

/ / /


.41


.


4,000

97


(fee for
service) (capitation)
(capitation)


(DRG) DRG
: 2551 ,
,