C URR ENT ISSUES

'corr ~conomjc model' of the effects of influenza vaccination, including clinicaJ data and resource typology, into which local European epidemiologica1 and economic da1a could be incorporated. Such a mcxlel could be used to provide an evidence base for policy decisions in each European country.

Hea1thcare decision-makers must be involved in the process of setting up pharmacoeconomic studies. pointed out Or 1bomas Szucs from the Medical Economics Research Group. Germany. This will ensure that the most relevenl questions are addressed. Socio­economic analyses must take into account clinical and epidemiological data. disease management strategies.

As a result oIlIlis workshop, ESWI has set up a task force to provide stronger evidence to policy-makers in order to extend coverage 01 influenza vaccination in Europe. The task force wiI begin by examining and extending the evidence for vaccine effectiveness and cost effec:tiyeness in Europe by considering dinical, economic and policy issues in paIaIIeI working groups. Results wi! be reported at a Mure meeting. Professor Claude HannoLWl is the overal chairperson for the task loroa.

unit costs, the reimbursement environment and local practice paucms.

I . Levy E. Levy P. InflUoe't\U. vacc;;naOOn for an IIClive popuJ.ujon aged 2S-64 yean: I cost·!)enefll study. Revue: d ' epidemiologic: eI. de Sante f'IIbLique 40: 285·295. 1992 (F~ochJ 2. Fedson OS. Hannoun C. Leese J. eI.

Ill. InnuclWl vaa:iMtioa in 18 developed countries. 1\180-1992. Vaccine 13: 623..627. 1995 _"' ..

Angioplasty lreabnent of choice for acute MI

It is difficult to argue against primary angioplasty as the treatmenl of choicc for acute myocardial infarction (MI). according to Dr Lee Goldman from the University of California-San Francisco School of Medicine. US. Recent clinical trials of patients with acute Ml suggest that primary angioplasty is asso­ciated with a 63% decrease in early morta1ity rates, compared with thrombolytic agents, with no increase in costs.

Hospitals without the resources for performing angioplasty need to consider the possibility of transferring patients for the procedure rather than administering thrombolytics onsite, says Dr Goldman . However, such a scheme should not lead to more than a 1-to 2-hour treatment delay, particularly in high­risk patients.

Should all hospitals perform angioplasty? He also asks whether the capabilities for perfonning

angioplasty should be extended to a larger number of medical institutions. Currently, only J 8% of US hospitals have the capacity to conduct this procedure. However, he points out that the additional costs incurred by these institutions to improve facilities and b'ain medical staff would be considerable, compared with those that already have the resources to perform angioplasty.

Also, the success of primary angioplasty is dependent on the capabilities of the medical team and the number of procedures they perform. Thus, providing primary angioplasty routinely in all hospitals is likely to be less cost effective than administering thrombolytics as soon as possible. he comments.

With regard to thrombolytic agents, Dr Goldman believes that the acquisition cost associated with alteplase (tissue plasminogen activator; tPA] 'will remain a deterrent ' to healthcare purchasers even if its cost-effectiveness ratio is 'reasolUlble' compared with streptokinase. The acquisition cost o f alteplase c urrently accounts for up to 50% of the incremental costs of the complete thrombolytic sb'ategy.

'Should our heaUh cart system b e willing to pay Ih is price, or should a national syslem b e able 10 negotiate a price rtducrion? ', queries Dr Goldman .

Goldman L COSIInd qu.ality of life: thrombolysis IfId primIry angiopllsty. Journal of the American CoIkgc of Cardiology 25 (Suppl.): 38-41. Jun 1995

Economic factors impede development of IL-12

Clinical development of interlcukin- 12 (IL- 12) in infectious diseases may be put on hold for economic reasons, according 10 Stcphen Hall, a wri ter for Scienct!.

A plethora of cncourag ing preclinical data on the potential efficacy of I~ 12 in infectious diseases prevalent in developing countries (e.g. leishmaniasis. malaria, tuberculosis and cytomegalovirus infection) were recently presented at a US meeting. ·

However, al the meeting. Genetics lnstirute and Hoffmann-LaRoche expressed a reluctance 10 initiatc clinical trials in these indications, said Mr Hall. Reasons for this reluctance included the risk of adverse effects and economics.

The revenues attained from providing JL..1 2 for thc treatment of infectious diseases in developing countries would definitely not offset the large manufacturing COSts associated with the drug, claims John Ryan from Genetics Institute. • National lnslilutes 0/ Heolth-sponsored meeting in BetMsdiJ, US - '1["12 inln/eclion: Prospt!ctsfor Prophylactic and 1'herapt!ulic Intervention'. Hall 55. (L..121l!be~. Scienee 268: \4)2· 14).4. \I Jun 19\1S -News in brief ...

• Cost minimisation is still the primary concern when making hospital pharmacy formulary decisions, according to Dr Alan Schrogie, Assistant Director of Health Policy at Thomas Jefferson Medical College, US. 'The initial responses to a survey of the other hospitals in the 67-member university hospital consortium reveal that pharmacoeconomic data are not used to guide formu lary decisions by 26 respon­dents, he reported. Often decisions regarding formulary inclusion involve 'the herd instinct', Dr Schrogie concluded.

HOIpiIll pIwmIcy c05Hninimizilion is sli1I f"" concern. fOC Reports -PiokShm : TaG4-5, IOJullIl1l5 _ ...

PHARMACORESOURCES 22 Jull tM

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