Pharmacoeconomics, Cost Studies, COST benefit analysis and other cost studies

Pharmaco-Economics

Pharmaco-economics is the study of economic aspects of the drugs or therapies or pharmaceutical interventions.

Pharmacoeconomics is the sub branch of health economics instead of focusing on other related thing like non-pharmaceutical interventions it only focus on monetary aspects for drugs.

The ultimate goal of Pharmacoeconomics is to study cost of therapy in comparison to the outcomes.

Why Pharmaco-economics is important?

To study the problems with high cost and low outcomes.

To bring about alternatives with batter outcomes and batter cost.

To prepare future goals which can be implemented for batter out comes in future.

To utilize the health care resources in a batter and appropriate way.

Type of Pharmacoeconomic studies

• 1)    Cost minimization analysis (CMA)
• 2)    Cost benefit analysis (CBA)
• 3)    Cost effectiveness analysis (CEA)
• 4)    Cost Utility analysis  (CUA)
• 5)    Cost Consequences analysis (CCA)

Note in cost consequences analysis CCA the outcomes of the therapy are different. And the cost may be same or different. The cost of the various drug with various outcomes is studies but no comparison is done.

6)    Cost of illness (COI) total cost during a disease condition is confirmed it include both direct and indirect cost.

Cost outcomes

To study various interventions may and to check their outcomes and cost assigned to each intervention.

Type of cost

• 1)    Direct medical cost (That cost which is directly spent on medical thing like doctor fee, medicines fee etc)
• 2)    Direct Non medical cost (this is indirect cost suppose you go to the doctor by taxy the fair come under this cost which is Direct on your disease but non medically.
• 3)    Indirect cost (loss of productivity, office leaves etc)
• 4)    Intangible cost (tension, aggression, pain, fear those thing which can be physically felt) 

Cost Minimization Analysis

Cost minimization analysis it the measure of the cost and out comes of various interventions or therapies having same out comes and to conclude effective strategy of it or to chose best possible alternatives on the bases of it. I.e studies done between Generics, pharmaceutical alternatives, and Home or hospital care treatment.

Cost Effective Analysis

  In cost effective analysis, effectiveness is given more preference over the cost. Suppose drugs having same outcome like H2 blockers and PPI used for ulcer. As PPIs are costly then the H2 blockers have same outcomes (both block Hcl secretion) but PPIs are more effective so they are selection with the reason of being costly. Doller or money value is not considered here, thing which is considered is the drug to be more effective.

Cost Utility Analysis

In cost utility analysis cost is measure in Money or dollar terms. While the outcomes or consiquences are measured in terms of QLAY and DALY. Quality adjusted life year and Disability Adjusted life years. Cost utility analysis shows the over all Burdon due to a disease. It covers all the aspect of disease to attain a batter life. QALY and DALY are inverse of each other. 0 DALY Shows perfect health with no disability and 1 DALY shows complete disability (death). While at the other Hand QALY 1 show a healthy life and 0 QALY show death.

Steps in Cost Utility Analysis 

1. 1)    Describe the Health State: In this step the health state or the condition of patient or a populations is commutatively described.
2. 2)    Chose the Instrument : in this step interventions are made which may be pharmaceutical or non-pharmaceutical. Instrument selection may be

Time Trade off (TTO): You make such intervention which improve the quality of the health to the high level 1 (complete health) but the life expectancy decrease. Suppose You dealing with a patient having heart peace maker problems. He can live badly with this condition for 70 Year with Disability. But you put artificial peace maker which make him completely healthy. He is now ok But due to problems with artificial peacemaker he may be able to live 50 years only in perfect health. TTO is (simply good health but with short duration).

Standard Gamble: You ask to patient to gamble over his life. In this case interventions are made on such base that after interventions patient may die or he may become completely health. Suppose an operation after which it is not sure that whether the patient will die or he will live with complete health.

Visual Analogue scale:- In this case the patient may be in between the death and complete illness. If he is completely ok shows the 100 vale and if he dies shows o value and if he is in between 50,40 or other values may be given to him.

1. 3)    Administer Instrument :- these instruments which are above are selected (one of the above) and applied on individual if more then one person or to whole population. Or applied to a person having specified disease or community.
2. 4)    Utility calculation calculate weather the individual or population is heading toward the improvement, improved or not. If improved 1 value is assigned and if dies 0 value is assigned.

ADVANTAGES OF CUA

Comparisons are made between different options available for treatment.

Disadvantages

Time consuming.

Some time it is not much accurate due to external factor. It is not always the after interventions expected results will come.

Cost Benefit Analysis

In cost benefit analysis the cost is measure in terms of money which is also the case and the outcomes are also measure in terms of money. Suppose a patient is ill and you give him therapy. So first you find the cost on the therapy. And when he become ok he starts happy life you also here gave cost value to the happiness and other things like productivity and feelings (happiness etc).

Advantage

Everything is in terms of money or cost so you can easily find the comparisons.

Disadvantages

It is difficult to assign values to each and every thing. Suppose a person become completely good and start happy life it is difficult to assign a vale to happiness (how you will say that he is 1 million rupees happy or 1 thousand rupees happy).