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SCHOOL OF

PHARMACEUTICAL
SCIENCES

Importance of
Pharmacoeconomic
Assoc Prof Dr Asrul Akmal Shafie
BPharm (USM), Pg Dip Health Econ (Trefforest), PhD (Cardiff)

aakmal@usm.my

Associate Professor International Fellow


School of Pharmaceutical Sciences International Society for
Pharmacoeconomic & Outcomes
Research
SCHOOL OF
PHARMACEUTICAL
Need for Rationing
SCIENCES

Scarcity forces us to choose, % Hospital Budget


ration, prioritize
Premature care

Cardiology
Nephrology
Rehabilitation
or Psychiatric
Geriatric service
SCHOOL OF
PHARMACEUTICAL
Solution?
SCIENCES
Criteria that Used to
Decide
SCHOOL OF
PHARMACEUTICAL
SCIENCES

Can it work? Does the health procedure, service, or


programme do more good than harm to people who fully
comply with the associated recommendations or
treatments? This type of evaluation is concerned with
efficacy.

A B

7 yrs 10 yrs Efficacy


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PHARMACEUTICAL
But, what if
SCIENCES

Evidence suggested 6 cancers


out of 10000 would not be
identified (false negatives) if only
one test was done.
If six tests were done, the number
of false negative would fall to
0.00003.
The American Cancer Society
endorsed a protocol of six
sequential stool tests (guaiacs)
for cancer of the large bowel.
The Case of Six
SCHOOL OF
PHARMACEUTICAL
SCIENCES Sequential Stool Test
Costs of diagnosing bowel cancer with stool test (Neuhauser & Lewiski 1975)

Number Total Total Average Extra Extra Marginal


of tests cases cost ($) cost ($) cases costs costs ($)
detected mil mil detected ($)
mil
1 235 525 277 1175 235 525 277 1 175
2
3
What can we do with
255 152
256 787
385
465
1507
1811
19 627
1 625
108
80
5 492
49 000
4
5 USD47mil? 256 924
256 935
529
583
2059
2268
137
11
64
54
470 000
4 700 000
6 256 936 630 2451 1 47 47 000 000
Criteria that Used to
Decide
SCHOOL OF
PHARMACEUTICAL
SCIENCES

Is it reaching those who need it? Is the procedure, service, or


programme accessible to all people who could benefit from it?
Evaluation of this type is concerned with availability.

A B

RM10 RM20 Price


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PHARMACEUTICAL
But, what if
SCIENCES

Price alone is not good enough criteria

A B

RM10 RM20 Price

RM100 RM10 Cost of


ADR
Treatment
What Should Be The
SCHOOL OF
PHARMACEUTICAL
SCIENCES Criteria to Decide ?
By efficacy? Economic evaluation
compared both cost and
By price?
consequences of
By cost? alternative
DRUG A DRUG B program/treatments.
BENEFIT
Survival 7 years 10 years
COST Aim is to achieves
Drug Price (unit cost) 10 20
Drug Price 3650 7300
1) a given benefit at
ADR Treatment 2000 50 lowest cost
TOTAL 5660 7370
2) gives greatest benefit
for a given
expenditure.
Case Study I:
SCHOOL OF
PHARMACEUTICAL
SCIENCES CEA HMR vs no HMR
SCHOOL OF
PHARMACEUTICAL
Case Study I: Design
SCIENCES

INTERVENTION GROUP; 2 home


visits by a pharmacist within 2 and 8
weeks of discharge; educate patients
and carers, remove out-of-date drugs,
inform GPs of drug reactions or
interactions and inform the local
- > 80y.o., Returning pharmacist if an adherence aid was
needed.
home from emergency
admission to hospital, >
2 discharge drugs
CONTROL GROUP; usual care

6 months
Case Study I: HMR more
expensive but
SCHOOL OF
PHARMACEUTICAL
SCIENCES

HMR CONTROL

Average total cost 1695 1424

Average cost 957 721


(intervention +
hospitalization)
Hospital Admission 234 178

Survival 0.4689 0.4618


QALY -0.0494 -0.0569
ICERa 33,541/LY
ICERb 54,454/QALY
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PHARMACEUTICAL
Case Study I: Results
SCIENCES

The intervention is more costly and more effective.


ICER (GBP34,541/LY; 54,454/QALY) > threshold (GBP30,000)
SCHOOL OF
PHARMACEUTICAL
Case Study I: Results
SCIENCES

A small non-significant gain in


QoL, no reduction in hospital
admissions and low probability
of cost-effectiveness.
Policy of MUR need to be
reviewed.

The CEAC shows that at GBP30,000, the intervention


has 25% probability of being cost-effective.
Evidences that Drive
SCHOOL OF
PHARMACEUTICAL
SCIENCES
HTA

Affordability
Efficiency
(a.k.a. CE)
Quality
Efficacy
Safety Budget
Impact
Analysis
Economic evaluation

16
Increasing
SCHOOL OF
PHARMACEUTICAL
Pharmacoeconomic Used in
SCIENCES
Drug Regulatory
SCHOOL OF
PHARMACEUTICAL
SCIENCES

Thank You