vPHARMACOECONOMICS IN

INDIA

COMPILED By: Sameer Shete

IINTRODUCTION:

HEALTHECONOMICS

PHARMACOECONOMICS

Cost and consequences of health care

interventions

Cost and consequences of Pharmaceutical

services.

Why is it necessary ?

COST OF ILLNESS

BORROWING DEBTS

POVERTY

INDIAN SCENARIO

• No Significant Improvement.

• Sir Bhor Committee.

• Alma Ata Declaration

• Central Procurement Agency

ISPOR - INDIA

• Established in MAY 2006

• PE guidelines for India

• To benefit stakeholders

GUIDELINES

1. Identify target groups of audience and type of analysis to be performed. Primary target : Ministry of health and family

welfare

Secondary targets : Patients , prescribers , suppliers, hospitals, insurers and researchers.

3. Justifications on choice of comparator

• Social perspective.

• Regardless of who incurs the cost or who receives the benefit.

2. Identify perspective of the evaluation

• Right comparative treatment is important.• Adhere to Indian situation.

4. Choice on use of Analytical technique to be used for PER

Analytical techniques

COST MINIMIZATION

ANALYSIS

COST CONSEQUENCE

ANALYSIS

COST EFFECTIVENESS

ANALYSIS

COST UTILITY ANALYSIS

COST BENEFIT ANALYSIS

Cost Minimization Analysis

• Only the costs of the alternatives need to be compared.

• Important to consider what happens when two drugs with similar efficacy and different adverse effect profile.

• Omeprazole – Lansoprazole

Cost Benefit Analysis

• Willingness to pay method

• Least popular

• Exceed the actual cost of therapy

Cost Effectiveness Analysis

• Cost of the drug treatments are weighed against the effectiveness of the drug.

• Cost of drug treatments :acquisition costs, physician involvement, and nursing costs for administration of the drug.

• Effectiveness of drug treatments: length of hospital stay , duration of treatment , mortality rate

Cost Utility Analysis

• Can combine more than one measure of effectiveness or both measures of mortality and morbidity into a single measure.

• Used when quality of life is the outcome of interest when both morbidity and mortality are important outcomes.

Cost Consequence Analysis

ADVANTAGES

Easily understood

Able to present the border range of health and non-health cost.

Alternative approaches to measuring costs and

outcomes

DISADVANTAGES

No specific or definitive guidance

Decisions may not be transparent

Limited Generalizability

5. Time horizon of a Pharmacoeconomic evaluation

• Capture all relevant outcomes.

• Assumptions should be explicit , well justified ,

And thoroughly tested by sensitivity analysis.

6. Cost identification, measurement and evaluation

• Direct costs within the healthcare system:

Medical costs of prevention, diagnosis, therapy.

• Direct costs outside the healthcare system:

Patient’s travelling expenses.

• Indirect costs within the healthcare system:

Medical costs which may arise during life years that have been saved.

• Indirect costs outside the healthcare system:

Human capital approach , friction cost method.

7. Assessing quality of life and QALYs

• Specific measures

• Generic measures

• Preference – based measures

• Wealth, freedom, political system, and cleanliness of the environment all contribute to the overall QOL.

8. Modelling

• Effectiveness data from efficacy data.

• Data from other country.

• Ideally, Pharmacoeconomic studies should report on drug effectiveness rather than efficacy.

9. Incremental analysis

• Differences between two alternatives.

• From the incremental analysis one can deduce what the (net) difference in costs and effects will be when the new treatment replaces the existing one.

10. Discounting future effects and costs

• If data on effects and costs are collected over a period longer than one year, then the effects and costs need to be discounted after the first year.

• In the primary analysis the costs should be discounted at a constant discount rate of 4%.

• Future effects should be discounted at a constant discount rate of 1.5%.

APPLICATIONS

CASE STUDY - 1 Management of Pain Resulting from Osteoarthritis

Treatment :

NSAIDs

• effective pain relief

• 24 – 30% the cost of Cox-II inhibitors

• associated with a significant risk of adverse effects

Dyspeptic symptoms

More serious non-dyspeptic effects- symptomatic ulcers, ulcer hemorrhage, ulcer perforation

Cox- II inhibitors

• effective pain relief

• substantially more expensive than NSAIDs

• associated with lower risk of GI side effects

• of Pain Resulting from Osteoarthritis

• With no history of GI bleed, choose naproxen

• With history of GI bleed, choose Cox-II inhibitor

• Cox-II inhibitor ---Cardiovascular events

CASE STUDY - 2

• Treatment of Acute Deep Vein Thrombosis:

Unfractionated heparin• Effective for treating VTE• Daily cost for IV therapy is low• Requires close monitoring of clotting time/ dose titration

and, therefore, hospitalization

Low molecular weight heparin• Effective for treating VTE• Daily cost for subcutaneous therapy is high• Routine clotting time monitoring not required unless

obese or manifestations of renal compromise present• Early discharge or outpatient treatment for VTE is possible