药物经济学研究的基本概念与方法

$
$/outcome-goal
$
$/quality of life index [Quality-
Adjusted Life Year (QALY)]
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HRQoL Used in CUA
• HRQoL/PROs have been shown to be stronger predictors of survival than computed tomography scans in patients with liver metastases associated with colorectal cancer. In these patients, assessment of QoL has been shown to provide a better estimate of survival than measurement of tumor size.
• Comparative Effectiveness Research (CER) vs. CEA
– Effectiveness (real world / real life) vs. efficacy (RCT)
Clinical Outcomes
Economic Outcomes
Humanistic Outcomes
• Inflation? Deflation? Stagflation?
– Borrow $1,000 today and return $1,000 in 5 years
• Discount rate
– Can estimate the present value of future expenditures or savings
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Demonstrating product value
• Safety: Benefit/risk (harm) eg, PPA, Vioxx, Avandia
➢ Cost-effectiveness
/journals/cpm/2008/04-April%202008/023-IMS.pdf
Relationship of Pharmacoeconomics to Other Research
Pharmacy-related clinical or humanistic outcomes research
Pharmacoeconomics
Health care economics
When to do economic evaluation?
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隐性成本 (Intangible Costs) • Pain and suffering • Fatigue • Anxiety
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Bringing Future Costs to Present
• Time value associated with money
– Give $1,000 today or $1,000 in 5 years
直接医疗成本 (Direct Medical Costs)
• Medications
• Hospitalizations
• Medication monitoring
• Clinic visits
• Medication administration • Emergency Dept. visits
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An Example
• Total hospital costs in 2004
– $22,538.10
• Need to convert to 2007 USD
– Medical Component of CPI
• 2004 = 4.4% 2005 = 4.3% • 2006 = 4.1% 2007 = 4.1%
Pharmacoeconomics research identifies, measures, and compares the cost (ie. resources consumed) and consequences of pharmaceutical products and services
Earlam S, Glover C, Fordy C, Burke D, Allen-Mersh TG. Relation between tumor size, quality of life, and survival in patients with colorectal liver metastases. J Clin Oncol 1996; 14: 171–175.
condition • Child care services for children of parents
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间接成本 (Indirect Costs)
• No money is exchanged. • Lost productivity for patient • Lost productivity for unpaid caregiver • Lost productivity because of premature mortality
Health Economics and Outcomes Research
• Why HEOR? – spend less, get more
– Health Technology Assessment (HTA)
• Health outcomes: ECHO model
– Health Related Quality of Life (HRQoL) / Patient-Reported Outcomes (PROs)
• Formula
– $22,538.10 X 1.044 X 1.043 x 1.041 x 1.041 = – $26,595.22 in 2007 USD
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Pharmacoeconomics
Definition
Pharmacoeconomics is the description and analysis of the costs of drug therapy to healthcare systems and society
Townsend RJ, Postmarketing Drug Research and Development Drug Intell Clin Pharm, 1987:21
Pharmacoeconomics
COSTS ($)
RX
OUTCOMES
Costs = costs associated w/ providing pharmacy product or service Rx = pharmacy product or service Outcomes = outcome of the product or service
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成本 (cost) 的分类
• 成本分为： – 直接成本
• 直接医疗成本 (direct medical cost) • 直接非医疗成本 (direct non-medical cost)
– 间接成本 (indirect cost) – 无形成本/隐性成本 (intangible cost)
• 另一成本分类： – 卫生服务部门的成本 (costs to health care sector) – 其他部门的成本 (costs to other sectors) – 患者及其家庭的成本 (patient and family costs) – 生产力成本 (productivity costs)
Source: Cox ER, Schafermeyer KW. Chapter 18--Pharmacoeconomics. In: McCarthy RL, Schafermeyer KW, eds. Introduction to Health Care Delivery: A Primer for Pharmacists. Sudbury, MA: Jones and Bartlett Publishers; 2007:481-508.
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Demonstrating product value –cont’d
• Efficacy – “Can intervention work in the ideal study setting?”
• Effectiveness – “Does it work, generalized to real-world settings and applied to individual patients?”
药物经济学的基本概念 与基本研究方法
张延军
2015年7月3日 上海
概要
• 卫生经济学和健康结果研究，Health Economics and Outcomes Research (HEOR) – 卫生技术评估, Health Technology Assessment (HTA)
• 药物经济学，Pharmacoeconomics – 视角 (perspective)、时间范围 (time horizon)、贴现 (discounting)、敏感性 分析
• Patient counseling & consultations
• Diagnostic tests
• Home medical visits • Ambulance services
直接非医疗成本 (Direct Nonmedical Costs)
• Travel costs to receive health care • Nonmedical assistance related to condition • Hotel stays for patient or family related to
• 药物经济学研究的基本方法 – 成本最小化分析, cost-minimization analysis (CMA) – 成本-效果分析, cost-effectiveness analysis (CEA) – 成本-效用分析, cost-utility analysis (CUA) – 成本-效益分析, cost-benefit analysis (CBA) – 疾病成本研究, cost of illness – 预算影响分析, budget impact analysis (BIA) – 成本-结果研究, cost-consequence analysis (CCA)
– 决策树, decision tree; 马可夫模型, Markov model
• TreeAge, MS Excel, R...
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EBM, HTA, and CER
Source: Luce BR, Drummond M, Jonsson B, et al. EBM, HTA, and CER: clearing the confusion. Milbank Q 2010;88:256-76. 3
• 视角/角度 (perspective)
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Government
HMO's
Patient
Hospital
Perspective
Insurer
Society
Health Care Professional
Potential Persห้องสมุดไป่ตู้ectives for Pharmacoeconomic Evaluations
• Cost-effectiveness – “Is it worth it and should it be paid for?”
Source: Djulbegovic, B. and A. Paul, From efficacy to effectiveness in the face of uncertainty: indication creep and prevention creep. JAMA, 2011. 305(19): p. 2005-6.
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Pharmacoeconomic Methodologies
Method of Analysis
Cost minimization
Cost benefit
Cost effectiveness
Cost utility
Cost
$
Outcome Measurement
Assumed equal
$
$/$(net benefit)