PHARMACOECONOMICS & DRUG COMPLIANCE Dr Naser Ashraf Tadvi

OBJECTIVES

Explain pharmaco-economics & prescription cost

Evaluate the cost-effective drug therapy Discuss the significance of pharmaco-

economics in various strata of society Explain drug compliance, adherence and

therapeutic failure Discuss consequences of non compliance

PHARMACO-ECONOMICS

Description and analysis of the costs and consequences of pharmaceutical products and services and their impact on individuals, health care system and society

Pharmacoeconomics

Relationship

Pharmaceutical Care

Cost

Consequences

CONSEQUENCES

Clinical

• Efficacy• Safety • Impact of therapy on “natural history” of the disease

Economic

• Cost consequence Analysis • Cost-of-Illness • Cost-Minimization• Cost-Benefit• Cost-Effectiveness

Humanistic

• Health Related Quality of Life• Patient Satisfaction• Caregiver Impact• Patient Preferences• Functional Status

PHARMACO-ECONOMIC METHODS

COST CONSEQUENCE ANALYSIS

All the relevant costs and outcomes of drug

therapy or healthcare intervention like direct

medical costs, direct nonmedical costs, indirect

costs , clinical costs etc are analyzed

For Example : Drugs used in stroke prevention

include drug cost, hospital cost , other costs and

include special monitoring , number of strokes

observed , number of deaths observed, the rate

of side effect

PRESCRIPTION/INVESTIGATIONS/OTHERS COST

PHARMACOECONOMIC METHODOLOGIES Method Description Application

Cost of Illness Estimates cost of disease on a defined population

Used to provide baseline to compare prevention and treatment options against

Cost Minimization Finds the least expensive cost alternative

Use when benefits are same

Cost Benefit Measures benefit in monetary units and computes net gain

For decision makers can compare programmes with different objectives

Cost effectiveness Compares alternatives with therapeutic effects measured in physical units

COST BENEFIT ANALYSIS

COST EFFECTIVENESS ANALYSIS

Cost effectiveness of any therapeutic intervention may be expressed in terms of natural units such as Life Years Gained (LYG) or infection avoided.

It may also be expressed in utility terms like Quality of Life (Quality adjusted Life years)

VALUE FOR MONEY : COST VERSUS BENEFIT

Drug costs + Out patient visits + Inpatient costs

More symptom free days

Less hospital admissions

Increased quality of life

Increased survival

Cost Benefit

COST EFFECTIVE PRESCRIBING

Prescribing generic drugs Adherence to evidence based medicine Prescribing safest therapies Prescribing the most cost effective options

SIGNIFICANCE OF PHARMACO-ECONOMICS Drug therapy evaluation Selecting the most cost-effective drugs for hospital

formulary Making a decision about individual patients therapy Determining value of existing service Helps government agencies in pricing, approval,

formularies and policy making For patient: cost can be reduced and better treatment Society : decrease in morbidity and mortality Provider: marketing, pricing and performance

guarantee

"Not everything that can be counted counts, and not everything that counts can be counted."

- Albert Einstein (1879-1955)

COMPLIANCE

The extent to which a person’s behaviour (in terms of taking medications, following diets or executing lifestyle changes) coincides with medical or health advice

More authoritative term Doctor dictates Patient follow`s or doesn’t follow

May be Partial Total Overcompliance

ADHERENCE

‘The extent to which a person’s behaviour – taking medication, following a diet and/or executing lifestyle changes – corresponds with agreed recommendations from a healthcare provider’

Implies active role of patient in collaboration with prescriber

Self motivated decision to adhere to treatment or advice

Self regulation of illness and treatment

NON ADHERENCE / NON COMPLIANCE

Delays in seeking medical care Failure to keep appointments Failure to follow intructions

Correct frequency of dosing Correct timing of dosing Correct administration of dosing Correct intensity of dosing Underuse, overuse,

HOW BIG IS THE PROBLEM?

Medicines cannot be effective if patients do not use them

There are varying estimates on the size of the problem: Between 33% and 50% of medicines

for chronic diseases are not used as recommended

20-30% don’t adhere to regimens that are curative or relieve symptoms

30-40% fail to follow regimens designed to prevent health problems

THE CHALLENGE

It is often a hidden problem undisclosed by patients unrecognised by prescribers

It has been suggested that increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments

Haynes R, McDonald H, Garg A, Montague P. (2002). Interventions for helping patients to follow prescriptions for medications. The Cochrane Database of Systematic Reviews, 2, CD000011.

WHY DON’T SOME PEOPLE USE THEIR MEDICINES AS PRESCRIBED?

1) They don’t want to(intentional non-adherence)

2) They have practical problems (unintentional non-adherence)

EXAMPLES OF UNINTENTIONAL NON ADHERENCE

A 62-year-old man requiring a metered-dose inhaler (for the first time) was told to 'spray the medicine to the throat'.

He was found to have been conscientiously aiming and firing the aerosol to his anterior neck around the thyroid cartilage, four times a day for two weeks (Chiang A A, Lee JC 1994 New England Journal of Medicine 330:1690).

A patient thought that 'sublingual' meant able to speak two languages;

CONSEQUENCES OF NON COMPLIANCE

Therapeutic drug failure Potential harm resulting from sub-optimal

management Sometimes increased clinical risk due to

additional prescribing Cost of medicines dispensed but not used Poorly managed chronic diseases can reduce

the economic contribution individuals can make to society

COMMON INTERVENTIONS TO IMPROVE COMPLIANCE

Educating patient on the medicine to increase their knowledge

Simplifying the regimen Making it easier to remember to

use the medicine (physical aids and reminders)

Direct observed Treatment

WHAT EVERY PATIENT SHOULD KNOW An account of the disease and the reason for

prescribing The name of the medicine The objective

to treat the disease and/or to relieve symptoms, i.e. how important the Medicine is,

whether the patient can judge its efficacy and when benefit can be expected to occur

How and when to take the medicine Whether it matters if a dose is missed and what, if

anything, to do about it How long the medicine is likely to be needed How to recognise adverse effects and any action that

should be taken, including effects on car driving Any interaction with alcohol or other medicines.

Doctors may smile at the ignorant naivety of patients, but the smile should be replaced by a blush of shame at their own deficiencies as communicators.