ESSENTIALS OFPHARMACOECONOMICS

Karen L. Rascati, PhDEckerd/Turley Centennial Professor of Pharmacy AdministrationUniversity of Texas College of PharmacyAustin, Texas

i Wolters KluwerHealthPhiladelphia Baltimore New York LondonBuenos Aires Hong Kong Sydney Tokyo

Lippincott Williams & Wilkins

CONTENTS

Part I Basic Topics

Chapter 1Introduction 1

PharmacoeconomicsWhat Is It? 2Why is Pharmacoeconomics Important? 2Relationship of Pharmacoeconomics to Other Research 3Types of Pharmacoeconomic Studies 4SUMMARY 7QUESTIONS/EXERCISES

/ 7REFERENCES f. 8SUGGESTED READINGS 8

Chapter 2Measuring and Estimating Costs 9

Costing Terms 10J Cost Categorization 10

Alternative Method of Categorization 12Perspective 13Timing Adjustments for Costs 13Resources for Cost Estimations 17SUMMARY 22QUESTIONS/EXERCISES 22REFERENCES 23SUGGESTED READINGS 23

Chapter 3Critiquing Research Articles 25

Appropriateness of Methods of Analysis 26Questions to Use When Critiquing Research Articles 26SUMMARY 32QUESTIONS/EXERCISES 32REFERENCES 33SUGGESTED READINGS 34

Chapter 4Cost-Minimization Analysis 35

Overview of Cost-Minimization Analysis 36SUMMARY 37Composite Article: CMA 38QUESTIONS/EXERCISES 43REFERENCE 45SUGGESTED READINGS 45

XI

CONTENTS

Chapter 5Cost-Effectiveness Analysis 47

Overview of Cost-Effectiveness Analysis 48Presentation of Costs and Effectiveness 48Cost-Effectiveness Grid 49Cost-Effectiveness Plane 51Intermediate Outcomes versus Primary Outcomes 55Efficacy versus Effectiveness 56Consensus and Debate 56SUMMARY 57Composite Article: CEA 57QUESTIONS/EXERCISES 65REFERENCES 65SUGGESTED READINGS 65

Chapter 6Cost-Utility Analysis (CUA) 67

Overview of Cost-Utility Analysis 68Steps in Calculating QALYs 68SUMMARY ' 73Composite Article: CUA 78QUESTIONS/EXERCISES 85REFERENCES 86SUGGESTED READINGS 87

Chapter 7Cost-Benefit Analysis 89

Definition and History 90Advantages and. Disadvantages of Cost-Benefit Analysis 90Conducting a Cost-Benefit Analysis 91Difference Between Costs Versus Benefits 92Measuring Indirect and Intangible Benefits 93Calculating Results of Costs and Benefits 98SUMMARY 100Composite Article: CBA 101QUESTIONS/EXERCISES 108REFERENCES 109SUGGESTED READINGS 109

Chapter 8Health-Related Quality of Life: Health Status Measures 111

Definitions 112Health-Related Quality of Life: Utility Measures versus Health

Status Measures 112Domains of Health Status 115Assessing Health Status Instruments 117Pharmacoeconomics and Health Status Measures 119Patient-Reported Outcomes 120SUMMARY 120Composite Article: HRQOL 121QUESTIONS/EXERCISES : 128REFERENCES 132SUGGESTED READINGS 134

CONTENTS x i i i

I PART II Advanced Topics !

Chapter 9Decision Analysis 135

What is Decision Analysis? 136Steps in Decision Analysis 136Threshold Analysis 140SUMMARY 143Composite Article: Decision Analysis 145QUESTIONS/EXERCISES 152REFERENCES 153SUGGESTED READINGS 153

Chapter 10Markov Modeling 155

Overview of Markov Modeling 156Steps in Markov Modeling 156Disadvantages of Markov Modeling 162Advanced Issues 163SUMMARY 164Composite Article: Markov Modeling 165QUESTIONS/EXERCISES 173REFERENCES 175SUGGESTED READINGS 175

Chapter 11Retrospective Databases 177

Overview of Retrospective Databases 178Randomized, Controlled Trials 178Observational Studies 178Advantages and Disadvantages of Randomized, Controlled Trials 178Advantages and Disadvantages of Observational Studies 179Types of Retrospective Databases . . -s 181Critiquing Retrospective Database Studies 184SUMMARY 185Composite Article: Retrospective Database 186QUESTIONS/EXERCISES 193REFERENCES 194SUGGESTED READINGS 195

Chapter 12Pharmacy Services 197

What Are Pharmacy Services? 198History of Pharmacy Services 198Review of the Research 198Issues in Valuing Pharmacy Services 201Medicare Medication Therapy Management . 202SUMMARY 204Composite Article: Pharmacy Services 205QUESTIONS/EXERCISES 212REFERENCES 213SUGGESTED READINGS 2t5

CONTENTS

Chapter 13International Perspective 217

Health Care Expenditures 218Comparability of Pharmacoeconomic Results Between Countries 218History of Pharmacoeconomic Guideline Development 218SUMMARY 223QUESTIONS/EXERCISES 224REFERENCES 225SUGGESTED READINGS 226

Chapter 14Future Issues 227

Application of Pharmacoeconomics in the United States 228Federal Agencies 228Private Health Care Plans 229Barriers to Pharmacoeconomics in the United States 230Other Future Issues 231SUMMARY 233QUESTIONS/EXERCISES 234REFERENCES '. 234SUGGESTED READINGS 235

Glossary . 237Index 243