pharmacoeconomics and outcomes research dean g. smith, ph.d. october 10, 2005 um student chapter
TRANSCRIPT
![Page 1: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/1.jpg)
Pharmacoeconomics and Outcomes Research
Dean G. Smith, Ph.D.
October 10, 2005
UM Student Chapter
![Page 2: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/2.jpg)
Senior Associate Dean for Administration
Professor of Health Management & Policy
Disclosure
![Page 3: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/3.jpg)
Prescription Drug “Inflation”
-6%
-4%
-2%
0%
2%
4%
6%
8%
10%
12%
14%
1947 1954 1961 1968 1975 1982 1989 1996 2003
![Page 4: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/4.jpg)
Co-Director, Michigan-Pfizer Pharmacoeconomics & Outcomes Research Fellowship Program
http://www.sph.umich.edu/hmp/admissions/pdfellowship.html
Disclosure
![Page 5: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/5.jpg)
The mission of ISPOR is to translate pharmacoeconomics and outcomes research into practice to ensure that society allocates scarce health care resources wisely, fairly, and efficiently.
![Page 6: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/6.jpg)
Further reading …
![Page 7: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/7.jpg)
Designed specifically to meet the clinical informational needs of managed care's Pharmacy and Therapeutics Committee Members.
Editors: Michael E. Chernew, Ph.D.
A. Mark Fendrick, MD
![Page 8: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/8.jpg)
Distribution of Hypercholesterolemia - US
<2F
CHD
2+RF
28%28%
Am J Cardiol 1998;82:61-5.
52%52%31%31%
17%17%
![Page 9: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/9.jpg)
Lovastatin (generic) $0.62Lovastatin (Mevacor) $1.28 Fluvastatin (Lescol 20) $1.67Atorvastatin (Lipitor) $2.18 $2.03Simvastatin (Zocor) $2.29 $2.13Rosuvastatin (Crestor) $2.42 $2.31Pravastatin (Pravacol) $2.67 $2.57
Online prices in the US: 10 mg, 90 tablets drugstore.com June 1, 2005, Medi-Span March 31, 2005
Drug Prices
![Page 10: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/10.jpg)
Drug Prices
Some prices may change Zocor - 2006 Pravacol - 2006 Lipitor - 2011 Crestor - 2016
Current analyses might think about future prices
Hamilton DP, Winslow R. Do statins help prevent cancer? Few tests slated. Wall Street Journal May 20, 2005, B1. B3.
![Page 11: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/11.jpg)
Member, Pharmacy Benefit Oversight Committee
Formulary: http://www.umich.edu/~benefits/plans/ drugs/formulary.htm
Disclosure
![Page 12: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/12.jpg)
Tier 1 $7 Lovastatin (generic)
Tier 2 $14 Atorvastatin (Lipitor) Pravastatin (Pravacol) Rosuvastatin (Crestor) Ezetimibe/Simvastatin
(Vytorin) Niacin/Lovastatin (Advicor)
Tier 3 $24 Lovastatin (Mevacor/Altoprev) Fluvastatin (Lescol/Lescol XL) Simvastatin (Zocor)
U Michigan Formulary
![Page 13: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/13.jpg)
“The mean statin copayment had a large effect on compliance. If the copayment increases by $15, the probability of compliance decreases by 10 percentage points.”
Doesn’t account for the process that might occur with selection of a Tier 2 or Tier 3 agent.
Pharmaceutical Economics
Schultz, O’Donnell et al. Determinants of compliance with statin therapy and LDL-C goal attainment in a managed care setting.American Journal of Managed Care, May 2005.
![Page 14: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/14.jpg)
Member, Board of Directors
MichiganNew Health Plan
Formulary: http://www.molinahealthcare.com/ michigan/provider/formulary.html
Disclosure
![Page 15: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/15.jpg)
StandardLovastatin (generic)Lovastatin (Altoprev)Atorvastatin (Lipitor 10 mg, 20
mg)Ezetimibe/Simvastatin (Vytorin)
Prior AuthorizationAtorvastatin (Lipitor 40 mg, 80
mg)
Molina Michigan Formulary
![Page 16: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/16.jpg)
HOWEVER, price is not value Claiming value requires a
comparison of costs and benefits Some purchasers care about value,
others only price per pill If you care about value, then there's
the short-run LDL-C change or guidelines/goals and the long-run mortality/QALY
Drug Therapy
![Page 17: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/17.jpg)
Week
% Responders
12 24 36 48 540
10
20
30
40
50
60
70
80
90Atorvastatin
Fluvastatin
Pravastatin
Simvastatin
Cumulative Responders
![Page 18: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/18.jpg)
0
500
1000
1500
2000
2500
AtorvastatinFluvastatinPravastatinSimvastatin
*
Total Cost to LDL-C Target
* p < 0.01 vs. others
Smith, McBurney. An Economic Analysis of The Atorvastatin Comparative Cholesterol Efficacy and Safety Study (ACCESS). Pharmacoeconomics, 2003.
![Page 19: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/19.jpg)
Willingness-to-Pay (NCEP)
Miller, Smith, Jones. Cost Effectiveness of Rosuvastatin in Treating Patients to Low-Density Lipoprotein Cholesterol Goals Compared With Atorvastatin, Pravastatin, and Simvastatin (a US Analysis of the STELLAR Trial). American Journal of Cardiology, 2005.
00.10.20.30.40.50.60.70.80.9
1
0 2000 4000 6000 8000 10000
R-10A-10A-40A-80
![Page 20: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/20.jpg)
![Page 21: Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter](https://reader035.vdocument.in/reader035/viewer/2022062802/56649ec55503460f94bcfb97/html5/thumbnails/21.jpg)
Questions
?