pharmacoeconomics & drug compliance
DESCRIPTION
pharmaco-economics and drug complianceTRANSCRIPT
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PHARMACOECONOMICS & DRUG COMPLIANCE Dr Naser Ashraf Tadvi
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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
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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
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Pharmacoeconomics
Relationship
Pharmaceutical Care
Cost
Consequences
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CONSEQUENCES
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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
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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
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PRESCRIPTION/INVESTIGATIONS/OTHERS COST
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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
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COST BENEFIT ANALYSIS
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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)
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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
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COST EFFECTIVE PRESCRIBING
Prescribing generic drugs Adherence to evidence based medicine Prescribing safest therapies Prescribing the most cost effective options
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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
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"Not everything that can be counted counts, and not everything that counts can be counted."
- Albert Einstein (1879-1955)
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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
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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
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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,
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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
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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.
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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)
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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;
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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
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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
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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.
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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.