Eslam Fahmy

https://t.me/splenotes
00201011922837
Types of Healthcare Cost Categories:
Direct
Direct medical
Fixed Capital • For setting up the service.
• Counselling rooms equipment.
Labor • Salary of pharmacists
Overhead • For running the service
• Lighting , heating , cleaning , rent
Semi fixed • Staff
Variable • Drugs, blood products, disposable equipment
Hospitalization
Ambulance services – Nursing services
Home medical visits / Clinic visits
Emergency department visits
Diagnostic tests
Direct non-medical • Patient and family expenses (e.g. transportation, caring)
• Travel costs (bus, gas, taxi)
• Hotel stays for patient or family
• Child care service for children of patients
• Food (Meals-on)

Indirect • Costs of ↓ productivity (e.g., morbidity and mortality costs).

o Lost wages (morbidity)
o Income forgone because of premature death (mortality)
Intangible • Anxiety
• Pain and suffering
• Fatigue
• Inconvenience
• Grief
Opportunity • Economic benefit forgone when using one therapy instead of the next best alternative therapy.
• Lost opportunity - Revenue forgone
Incremental • Additional cost that a service or treatment alternative imposes over another compared with the additional effect, benefit, or outcome it provides.
 Eslam Fahmy
https://t.me/splenotes
00201011922837
Models of Pharmacoeconomic Analysis
Cost Minimization Analysis Cost Benefit Analysis Cost Effectiveness Analysis Cost Utility Analysis
(CMA) (CBA) (CEA) (CUA)
Example • Comparing drug A to drug B • The benefit to cost ratio of: • Drug A (5$) and drug B (10$) • Measure the effect of an
• Drug A saves you 5$ ✓ Hiring a pharmacist = 1.25 • Both have the same action intervention on health units
• Hibiotic & Augmentin  Automated system = 1.15 • Drug B cause no gastric that measure both quantity
Pharmacist is better than the irritation as drug A. and quality of life.
automated system. • Aspirin and Aspirin enteric • Cancer patient without
coated treatment lives for short time
in great pain but with
treatment lives for longer time
in less pain
Type of Equivalent Economic Clinical Humanistic
outcome
Outcome Assumed to be equivalent in Monetary outcome ❖ Natural units Quality Adjusted Life Year
measurement comparable groups analysis. Dollars $ • mmHg blood pressure (QALY)
unit • mmol/L blood glucose = utility X expected length of time
• Case cure yes or no
Cost
measurement Dollars $ Dollars $ Dollars $ Dollars $
unit
Notes • The two drugs must be ❖ Measured by: ❖ Both must have the same ❖ Outcomes assess patient's
equivalent therapeutically • Human Capital (HC) unites to be compared. functional status or quality of life
then we determine the least • Willingness To Pay (WTP) ❖ Calculated by: ❖ Calculated by:
costly alternative. • Average Cost Effectiveness • Rating Scales (RS)
Ratio (ACER) • Standard Gamble (SG)
• Incremental Cost Effectiveness • Time Trade-Off (TTO)
Ratio (ICER)
• Symptoms Free Days (SFD)
• % healed
 Eslam Fahmy
https://t.me/splenotes
00201011922837

❖ Pharmacoeconomic definition:
• Description and analysis of the cost of drug therapy to healthcare systems and society.
 Eslam Fahmy
https://t.me/splenotes
00201011922837
Economic outcome assessment
Cost • The value of the resources consumed by a program or drug therapy of interest.
Total • All expenses directly and indirectly.
Average • The average cost per unit of output.
Marginal • Extra cost of producing one extra unit of output.
Incremental • Additional cost.
Operating • Supports the operation to provide the output.
❖ Types of Healthcare Cost Categories: direct, indirect, intangible, incremental, opportunity
Consequence • The effects, outputs, and outcomes of the program or treatment alternative.
• Types of outcomes (ECHO model)
Economic • The direct, indirect, and intangible costs compared with the consequences of medical treatment alternatives.
Clinical • The medical events that occur as a result of disease or treatment (e.g., safety and efficacy end points)?
Humanistic • The consequences of disease or treatment on patient functional status or quality of life along several
dimensions (e.g., physical function, social function, general health and well-being, and life satisfaction)
Positive • Is a desired effect of a drug (efficacy or effectiveness measure), possibly manifested as cases cured, life-years
gained, or improved health-related quality of life (HRQOL).
Negative • Is an undesired or adverse effect of a drug, possibly manifested as a treatment failure, an adverse drug reaction
(ADR), a drug toxicity, or even death.
Intermediate • Can serve as a proxy for more relevant final outcomes.
• Example: achieving a decrease in low density lipoprotein cholesterol levels with a lipid-lowering agent is an
intermediate consequence that can serve as a proxy for a more final outcome such as a decrease in MI rate

Perspective • the point of view from which a pharmacoeconomically study is conducted.

• It is important to understand the study perspective because it determines which outcomes and costs will be measured.
Ex: If comparing the value of Alteplase (tissue plasminogen activator, or t-PA) with that of Streptokinase.
From a patient or societal perspective From a small community hospital's perspective
t-PA may be the best-value alternative because a 1% reduction in streptokinase may represent a better value because it provides
mortality rates is observed in this large population. similar outcomes for less money.
❖ Common perspectives include those of the:
1- Patient.
2- Provider.
3- Payer.
4- Society.