Essentials of Pharmacoeconomics

266 Pages·2008·1.03 MB·English

by  Karen Rascati

E
SSENTIALS OF
P
HARMACOECONOMICS
Karen L. Rascati, PhD
Eckerd/Turley Centennial Professor of Pharmacy Administration
University of Texas College of Pharmacy
Austin, Texas
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Library of Congress Cataloging-in-Publication Data
Rascati, Karen L.
Essentials of pharmacoeconomics / Karen L. Rascati.
p. ; cm.
Includes bibliographical references.
ISBN-13: 978-0-7817-6544-2
ISBN-10: 0-7817-6544-7
1. Chemotherapy—Economic aspects. 2. Drugs—Cost effectiveness. 3.
Pharmacy—Economic aspects. I. Title.
[DNLM: 1. Economics, Pharmaceutical. 2. Costs and Cost
Analysis—methods. 3. Models, Economic. 4. Pharmaceutical
Preparations—economics. 5. Pharmaceutical Services—economics. QV 736
R222e 2009]
RM263.R37 2009
338.4’76151—dc22
2007036322
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described and recommended may not be considered absolute and universal recommendations.
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dosage set forth in this text are in accordance with the current recommendations and practice
at the time of publication. However, in view of ongoing research, changes in government regu-
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I dedicate this book to my mother, Glenna Rupp Lewis, whose lifelong
support and belief in me helped shape my career choices, first as a
pharmacist and then as an academician. Although she is officially
retired from her nursing career (and from raising five children), she
recently won an award for her work as a hospice volunteer. During the
time I was working on this book, she was genuinely interested in its
progress, and her encouragement was appreciated more than I can say.
I would also like to thank my husband, Joe, and my daughters, Maria
and Michelle, for their continued patience and understanding during my
preoccupation with this project.

P
REFACE
Need for This Textbook
The term “pharmacoeconomics” first appeared in the literature in the mid-1980s.
Pharmacoeconomics incorporates methods from more established disciplines to help
estimate the value of pharmacy products and services by comparing costs and out-
comes. Pharmacoeconomics is included in the curricula of more than 90% of US col-
leges of pharmacy, although often as part of a course rather than as a whole course.
The Accreditation Council for Pharmacy Education (ACPE) has developed standards
and guidelines for professional programs in pharmacy leading to a PharmD degree
(adopted in January 2006 and effective as of July 2007); these include an outline of
the subject matter that should be included in pharmacy school curricula. The fol-
lowing topics are listed in the ACPE document (see http://www.acpe-accredit.
org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152006.pdf) under the
Economics/Pharmacoeconomics heading: economic principles in relation to pharma-
coeconomic analysis, concepts of pharmacoeconomics in relation to patient care, and
applications of economic theories and health-related quality of life concepts to
improve allocation of limited health care resources. This book covers the application
of economic-based evaluation methods to pharmaceutical products and services and
includes examples of how pharmacoeconomic evaluations relate to decisions that
affect patient care and how health-related quality of life (HRQoL) is assessed and val-
ued. Understanding these principles helps providers and decision makers improve
clinical and humanistic outcomes based on available resources.
Intended Audience
Essentials of Pharmacoeconomics is designed for the true beginner—a student or
practitioner who may not have even heard of the term “pharmacoeconomics.” The
purpose of the book is to introduce the fundamental topics, define the terminology
used in pharmacoeconomic research, and give many examples in evaluating pub-
lished research so that readers can evaluate literature relevant to their future or cur-
rent practice. When readers have completed the book, they should be able to
understand, interpret, and determine the usefulness of pharmacoeconomic
research articles. This textbook can be used for PharmD students at any level of
their professional education.
The distinction of this textbook, compared with other textbooks on the subject,
is that it is written at an introductory level and provides many practical examples.
Another advantage of the book is that it was written by one author. This helps
ensure a clear flow in providing the information and an elimination of the unin-
tended redundancy sometimes seen in textbooks with multiple authors.
Please note that this is not intended to be an economics textbook, nor is it intended
for graduate students who would need to know more about the theory of economics
v
vi PREFACE
and the statistics or mathematical computations involved in the analyses. Moreover,
the purpose is not to train a future pharmacoeconomics researcher but to give a cur-
rent or future practitioner the knowledge and skills needed to understand and use
pharmacoeconomics research (conducted by someone else) in his or her decision
making.
Organizational Philosophy
This book follows the outline of a course taught to PharmD students by the author
for more than 10 years (and updated annually). Part I (Chapters 1 through 8) cov-
ers the basics of pharmacoeconomics. The author recognizes that not all colleges of
pharmacy have a whole course devoted to pharmacoeconomics. If this book is used
in a course that includes other topics and time allotted to pharmacoeconomics is
limited, Part I of the book could stand alone as an introduction that covers the
essential topics outlined by ACPE. Part II (Chapters 9 through 14) includes addi-
tional topics that are more complex (e.g., modeling) or may be of further interest
to the reader (e.g., international use of pharmacoeconomics).
Part I: Basic Topics
Chapter 1 serves as an introduction, stressing the importance of the use of pharma-
coeconomics to compare costs and outcomes of pharmacy interventions. The chap-
ter discusses four basic types of pharmacoeconomic research: cost-minimization
analysis (CMA), cost-effectiveness analysis (CEA), cost-utility analysis (CUA), and
cost-benefit analysis (CBA). All four analyses include the measurement of costs but
differ in the methods used to measure outcomes. Chapter 2 covers the measure-
ment of costs, and Chapter 3 outlines basic questions readers should ask when
evaluating any pharmacoeconomic study. Chapters 4 through 7 expand on each of
the four types of studies (CMA, CEA, CUA, and CBA) by reviewing the methods
used to measure outcomes for each particular type. Chapter 8 provides an overview
of health-related quality of life (HRQoL) measures.
Part II: Advanced Topics
Chapter 9 outlines the use of decision analysis methods to model costs and outcomes
that can be summarized in a single cycle. Chapter 10 explains Markov modeling,
which is used for analyzing costs and outcomes that are estimated using multiple
cycles. Chapter 11 discusses the advantages and disadvantages of using retrospective
databases. Chapter 12 reviews the unique issues involved in evaluating the costs and
outcomes associated with pharmacy services. The last two chapters address the use of
pharmacoeconomic research in decision making. Chapter 13 summarizes the use of
pharmacoeconomic evaluations by decision makers outside of the United States, and
Chapter 14 outlines the extent to which pharmacoeconomic data are used to make
decisions in the United States, includes barriers to its use, and discusses future issues.
Features
Essentials of Pharmacoeconomics contains the following elements that are geared
toward the pharmacy student:
PREFACE vii
• Composite research articles that incorporate the positive and negative aspects
found in a mix of published research articles. Most chapters contain a compos-
ite article. Depending on the classroom time allotted to pharmacoeconomics,
these composite articles can be included as part of the didactic portion of the
course, or they can be incorporated into small group discussion sections or
assigned as homework. (Although topics are taken from actual articles, methods
and data have been changed to illustrate points made in the chapter. Medication
names in these composite articles are fictitious.)
• Key terms are bolded throughout the textbook, and definitions of these terms
are summarized in a glossary. Pharmacoeconomics research uses terminology
derived from other disciplines, such as economics, that might not be familiar to
all readers.
• Examplesprovide added information or instances from the literature about the
chapter topic and reinforce chapter concepts. Most chapters have at least one
example.
• Equations readers will need to know are explained using multiple example
calculations.
• Summaries highlight and reinforce the main points of each chapter.
• Questions/Exercisesappear at the end of each chapter so that readers can assess
their understanding of key concepts. Instructors can find answers to these prob-
lems on the book’s companion website.
• References andSuggested Readingsat the end of each chapter provide resources
available to the reader for further study on the chapter topic.
Student and Instructor Resources
Student Resources
A Student Resource Center at http://thePoint.lww.com/rascati includes the follow-
ing materials:
• An Image Bank that contains the figures and tables from the textbook
• A sample worksheet that includes the 14 questions you should use when
critiquing a research article
Instructor Resources
In addition to the student resources just listed, an Instructor’s Resource Center at
http://thePoint.lww.com/rascati includes the following:
• Answers to the questions/exercises found in the text
Acknowledgments
Three of the chapters in the book are based on previous chapters cowritten with
colleagues: Dr. James Wilson (Chapter 1), Dr. Jamie Barner (Chapter 7), and
Dr. Gábor Vincze (Ch. 8). Another colleague and good friend, Dr. Carolyn Brown,
served as my “sounding board” for some of the ideas for this book. My major advi-
sor, Dr. Carole Kimberlin, has long served as one of my role models. Her author-
ship of a textbook inspired me to consider this endeavor.
viii PREFACE
I would like to thank both the professional (PharmD) and graduate students at
the University of Texas. Their intelligence and inquisitiveness, plus their insightful
questions, keep me “on my toes” and current in the field. I would also like to thank
my able Administative Associate, Iris Jennings.
I would like to thank Meredith Hodges, Dr. Kenneth Lawson, and Dr. Esmond
Nwokeji for proofreading various parts of this book. Their comments were especially
helpful.
I would also like to thank the people I have met and worked with through the
International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
Dr. Marilyn Dix-Smith has guided this organization to international prominence.
When I participate on ISPOR committees or attend ISPOR meetings, I am re-ener-
gized by other people with an interest in and a passion for this field of study.
And last, but definitely not least, I am indebted to the reviewers for their excel-
lent advice on ways to improve on the first drafts and to the editors and staff at
Lippincott Williams & Wilkins/Wolters Kluwer. To David Troy, who finally con-
vinced me to write this book; to Meredith Brittain, for her gentle prodding that kept
me on schedule; to Barrett Koger, who kept the project on track; and to the staff,
who transformed my ideas into this polished result.