Pharmacoeconomics Lecture Notes PDF

P E Pharmacoeconomics Dr. Alaa Essmat Pharmacoeconomics  ECU-University P E Faculty of Pharmacy Pharmacoeconomics Dr. Alaa Essmat Lecture (9) Pharmacoeconomics  P E...

P E Pharmacoeconomics Dr. Alaa Essmat Pharmacoeconomics  ECU-University P E Faculty of Pharmacy Pharmacoeconomics Dr. Alaa Essmat Lecture (9) Pharmacoeconomics  P E Lecture Outline Importance of Pharmacoeconomics’ Applications. Challenges of Pharmacoeconomics. Rational drug use. Economy in clinical pharmacy. Pharmacoeconomics  P E Importance of Pharmacoeconomics’ Applications Drug therapy evaluation. Selecting the most cost-effective drugs for hospital formulary. Making a decision about individual patient’s therapy. Determining the value of existing service. Helps government agencies in pricing, formulary approval, and policy making. Pharmacoeconomics  Cont. ……..Importance of Pharmacoeconomics Application P E For: Patient: Cost can be reduced and better treatment. Society: Decrease in morbidity and mortality. Provider: Marketing, pricing, and performance guarantee. Pharmacoeconomics  P E Challenges of Pharmacoeconomics Pharmacoeconomics  P E Challenges of Pharmacoeconomics Barriers to Using Pharmacoeconomic Information The Role of Pharmacoeconomic Information From the Pharmaceutical Industry Perspective E P. Armstrong, et al., PharmD Drug Benefit Trends 100 90 80 70 60 50 40 30 20 10 0 Lack of No Long Term SiloLack Budged of Lack of Lack of Credible Lack of Relevant Expertise Focus professional Resources PE PE staff Pharmacoeconomics  P E Cont. Challenges of Pharmacoeconomics * Standardizing the methods and establishing guidelines for specific practice. * Stable funds allocated for the evaluation process. * Training and education in data analysis. Pharmacoeconomics  P E Cont. Challenges of Pharmacoeconomics  Varying in estimating some results related to patients because: Between 33% - 50% of medicines for chronic diseases are not used as recommended. 20-30% of patients don’t adhere to regimens that are curative or relieving symptoms. 30-40% fail to follow programs designed to evaluate health care outcomes. Pharmacoeconomics  P E Pharmacoeconomics & Rational Drug Use Pharmacoeconomics  P E *Why worry about medicine usage ??? Drugs are essential to health care, to save lives, decrease suffering and improve health. Drug availability promotes trust in health services. Drugs are costly to both patients and the Government. Drugs are different for similar consumers since the prescribers and users are often different. Inappropriate drug use can be harmful. Pharmacoeconomics  P E Drug Misuse Vs. Drug Abuse Drug Misuse Drug Abuse Using a medicine or drug in the wrong way Intentionally taking medications for non- rather than the recommended use. medical reasons.  Examples:  Examples:  Failing to follow instructions in the insert  Taking a drug to lose weight instead of leaflet. changes in diet and exercise.  Taking medicine for a longer or shorter  Taking Sedatives, or CNS stimulants without period than recommended (stopping prescriptions. antibiotics before the course gets out) Pharmacoeconomics  P E Rational use of medicines means:- 1. Usage of Correct drug in proper indication. 2. Considering efficacy, safety, suitability, and cost for each patient. 3. Offering appropriate dosage, route of administration, and duration length. 4. Minimal incidence of side effects. 5. No contraindications. 6. Correct dispensing, including fair information for patients. 7. Patient adherence to treatment. Pharmacoeconomics  P E Ratıonal drug use Right drug Right patient Right indication 7R Right dose Right route Rigtht duration Right price Pharmacoeconomics  P E Ratıonal drug use “Patients must receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community.” (WHO, 1985). Pharmacoeconomics  P E Health care system In the USA  Hospital Pharmacy  Community Pharmacy  Clinical Pharmacy  Clinical Pharmacokinetics  Clinical trial safety Pharmacoeconomics  P E Irrational Drug Use example Drug use in improper indication. Wrong drug in specific disease. Use of drugs without evidence for some indications. Pharmacoeconomics  P E Example of: Irrational Drug Use Parenteral “Meloxicam” is used as pure analgesic  Registered in treatment of Osteoarthritis?  It is not analgesic! Mobic®, Mobicox®, (meloxicam) is a non-steroidal anti-inflammatory drug indicated for: Symptomatic treatment of painful osteoarthritis (degenerative joint disease) Symptomatic treatment of rheumatoid arthritis Pharmacoeconomics  P E Example of: Irrational Drug Use Micardis® (telmisartan) Tablets, 20 mg, 40 mg and 80 mg Rx only Prescribing Information *Dosage and admınıstratıon - Dosage must be individualized. The usual starting dose of MICARDIS (Telmisartan) tablets is 40 mg once a day. - Blood pressure response is dose-related over the range of (20 - 80 mg). *20 mg and 40 mg forms are registered, but not available in the market! WHY???.. Pharmacoeconomics  P E Factors affecting irrational drug use Patient Wrong information (TV, Social media) Misleading beliefs. Non-relaible information source. Self-medication. Patient demand/expectation. Patient economic status. Pharmacoeconomics  P E Factors affecting irrational drug use Physician Uncertainty of diagnosis. Overloaded patient duty. Poor communication with patients. Prescription pressure: * Industry * Patients * Promotions Unethical drug business!! Pharmacoeconomics  P E Factors affecting irrational drug use Pharmacist Industry No standard drug Unethical practice information source No prescription control Misleading claims Insufficient staffing Profit-driven attitude Pharmacoeconomics  P E Types of Irrational Prescriptions The use of too many medicines prescribed by doctors may result in cross-reactions between different drugs Inappropriate prescription of antimicrobials for non-bacterial infections. Over-prescription of injections when oral formulations would be more appropriate. Failure to prescribe in accordance with clinical guidelines: {wrong choice of drugs, inadequate dosages, incorrect frequency of administration of drug or improper duration of therapy, or failure to observe drug contra-indications.} Pharmacoeconomics  P E Cont...Types of Irrational Prescriptions Under-use of life-extending drugs for illnesses (hypertension, heart disease, asthma, and other chronic illnesses). Choice of more expensive drugs when less expensive drugs would be equally effective. Prescription of drugs which have no added value. (only for impressing the patient ) Inadequate consulting time, very short dispensing time, and poor communication of information regarding drugs to patients in verbal or written form leading to incorrect use by patients. Pharmacoeconomics  P E Challenges of Drug Affordability Many doctors do not know or care to know the costs of the drugs they prescribe. They have poor knowledge of the comparative costs of different brands, which adds to the difficulty of making a rational choice for their patients. Drug promotion by drug companies is based on promoting the brand drugs of higher cost through the doctors. Governmental health insurance does not cover all populations. Pharmacoeconomics  P E Outcomes of irrational drug use Degeneration Increased risk of treatment Waste of of adverse Psycho-social quality resources effect outcomes Morbidity Decrease Mortality availability Adverse Unneeded Increased expectations reactions from drugs price Bacterial Feeling of resistance uncured Economıcal loss cost on human beıng? Pharmacoeconomics  P E Strategies to Improve the Use of Drugs Educational: Managerial:  Inform or persuade  Guide clinical practice – Health providers – Information systems. – Consumers – Drug supply / lab capacity Use of Medicines Economic: Regulatory:  Offer incentives  Restrict choices – Institutions – Market or practice controls – Providers and patients – Enforcement Pharmacoeconomics  P E Public education about medicines Running public health education campaigns, which take into account cultural beliefs and the influence of social factors. Education about the use of medicines may be introduced through targeted programs such as:- literacy courses, Posters, leaflets, slogans, films, and other educational materials could be used. The focus of public education should be against common irrational drug use beliefs about modern medicine especially (energizers, nutritional supplements, tonics, …etc. ) Pharmacoeconomics  P E Managerial measures to support rational drug use Governments have a responsibility to ensure both the quality of medicines and the quality of the information about medicines being available to consumers. This will require: ensuring that all medicines are dispensed with adequate labeling and instructions and all product information is accurate, legible, and easily understood. The information should include the medicine name, indications, contraindications, dosages, drug interactions, and warnings concerning unsafe use or storage. Drug supply system to ensure medicines’ availability and their rational use. Pharmacoeconomics  P E Need for “Essential drug list” It is estimated that out of about 70,000 formulations available in the pharmaceutical market today, only about 300-400 pharmaceutical compounds are capable of providing all the useful therapeutic value that any medicine can provide for any type of illness. Another large set of formulations is made of drugs that have no real therapeutic value or have much less value than the essential drug preparations ( eg: some cough syrups, tonics, gripe waters, digestives, energizers…etc ) 4 out of 5 vitamin preparations are irrational. (60-80% ) of cough & cold remedies are irrational. Pharmacoeconomics  P E Regulatory measures to support rational drug use Licensing of any medicine outlets (retail drug stores, wholesalers, … ) Monitoring and regulating medical promotion. Regulating the advertisements of medicines, which may adversely influence consumers may occur through television, radio, newspapers, and the Internet. Need for regulation of the generic pharmaceutical market Urgent need to enforce the “Essential Drugs List” as a guide for better medical practice. The health system should be more organized (preventing prescribers & clinics from dispensing or selling medicines) Pharmacoeconomics  Changing a Drug Use Problem P E (An Overview of the Process) 1. Examine Measure the Existing Drug use Practices 4. Follow up improve 2. Diagnose Evaluate Changes diagnosis in Outcomes Identify Specific Problems and Causes (Rational Drug Use) ( of irrational use improve Health care 3. Treat Design Pharmacoeconomic analysis and implement corrective measures Pharmacoeconomics  P E *Pharmacoeconomic studies ensure the evidence for: “Rational Drug Use” Pharmacoeconomics  P E -Pharmacogenomics is the study of the role of the genome in drug response. -Its name (pharmaco- + genomics) reflects its combining of pharmacology and genomics. -Pharmacogenomics analyzes how the genetic structure of an individual affects his/her response to drugs. Pharmacoeconomics  P E *The Pharmacogenomics role in the rational drug use Predicting a patient’s response to drugs. Developing “customized” prescriptions. Increasing the accuracy of determining appropriate dosage of drugs. Improving efficacy and patient compliance. Minimizing or eliminate adverse events. Finally, improving the rational drug development and usage…..Explain in more details !!! “The Pharmacogenetic test need only be conducted once during the life time”. Pharmacoeconomics  P E Benefits of rational drug use Better health care. Better drug management and health outcomes (including the quality of the prescribed medicines). Cost-effective use of health resources. Adjusting of the public drug expenditure. Pharmacoeconomics  P E Pharmacoeconomics Role in Clinical Pharmacy Effective drug Will the patient take Safe drug the best therapy? therapy therapy Aims of What does the Pharmaceutical patient view as an Care improved quality of life? Improve Economic drug quality of life therapy Pharmacoeconomics  P E Pharmacoeconomics Role in Clinical Pharmacy Pharmacoeconomics can be useful in:- *Determining the value of an existing service. *Estimating the potential worth of implementing a new clinical intervention, or capturing the value of the available one. *Finally taking the right decision. Pharmacoeconomics Decisions of Pharmacoeconomics Applications in Clinical Pharmacy P E MICRO Clinical Decisions Formulary Management Drug Use Guidelines Disease Management Justification of Pharmacy Services Resource Allocation MACRO Pharmacoeconomics  P E Conclusion Pharmacoeconomics can guide choices among alternative medications, treatment regimens, and services based on a combination of costs and outcomes. Results and interpretation of pharmacoeconomic studies are influenced by the perspective of the study. (Sometimes, there is no one “right” answer.) Time and money can only be spent once- the choice is a must. Health care professionals should constantly evaluate the healthcare choices for their patients. Application of pharmacoeconomics and outcomes research can enhance the quality of the Pharmacist’s practice and increase the expectation that the pharmacist delivers better value in patient care. Pharmacoeconomics  P E Pharmacoeconomics  Questions P E 1) “Application of pharmacoeconomics has a great value for patients , society and health providers.” Explain How ? 2) Write short notes on : a- Challenges of pharmacoeconomics. b- Rational use of medicines. c- Pharmacist role in safe and economic drug utilization. 3) “Irrational medication use has a negative effects on the national economy” a- What are the main factors may lead to misuse of drugs. b- What are the psycho-social outcome of irrational medication on the patients c- Give an overview on a process for changing a drug use problem. Pharmacoeconomics  P E Pharmacoeconomics Pharmacoeconomics