INTRODUCTION Healtheconomicsis new concept that is being practiced only from past few decades.Healtheconomics concentrates in treating the population with more efficientdrugs with less cost. This is the one which started the concept ofPharmacoeconomics which considers both the cost and the benefit of a therapy tobe used in the population. Pharmacoeconomics is aimed to balance with both costand ethics at the same time, which is not completely developed yet. Theincrease in cost of the treatment and emergence of number of efficient drugshas lead to more research in Pharmacoeconomics. Pharmaceutical companies aredoing the Pharmacoeconomic studies as a part of their Post marketingSurveillance to assess the efficacy along with cost effectiveness of the drug (Rychlik,2002).NEED FORPHARMACOECONOMICS:Theincrease in the disease burden globally has alarmed the health community tomove towards better treatments not only in terms of efficacy and safety also interms of cost.
Many new drugs areintroduced to the market for various diseases like cancer, Neuropsychologicaldisorders, HIV etc. But the drawbackwith these drugs is they are not cost effective which is keeping them away fromcommon man. So it is not only necessaryto have an effective and safe drug but also it is necessary to have a costeffective drugs in the market to reduce the disease incidence globally. Properplanning and application of pharmacoeconomics from the first day of drugdevelopment is necessary to attain more efficient drugs with lesser costs. DIFFERENT METHODS OFASSESSMENT:Thereare different methods used to evaluate pharmacoeconomics of drugs and devices.The most common method used is Cost effectiveness analysis, Cost benefitanalysis. Cost utility analysis, cost minimization analysis.
These commonlyconsider the factors like cost incurred for the treatment, efficacy of thedrug, quality of life etc. The Cost minimizationanalysis is the most simpler amongall. This method does not consider the efficacy or quality of life parameters.The treatment with less cost should be given to patients according to thisanalysis.
This analysis can be used only in conditions where in the outcomesare same for both the treatments, the difference lies only in terms ofcost. The Cost effectivenessanalysis is most commonly employed in decidingthe type of treatment to be used. In this analysis the efficacies of differenttreatments are considered in numerator and the costs of the treatment areconsidered in the denominator.
The difference is measured to decide to go aheadwith which treatment. The efficacy parameters can be of different typesdepending on the disease type. For example in case of cancer therapies thenumber of years of survival or relapse free years of survival (Hillner, 1998)is the common parameters taken in the numerator in case of cancer patients. Themajor disadvantage with this analysis is that if efficacy parameters areassociated with the two treatments are not similar then it is difficult analyzethe cost-effective analysis. The cost Utility analysisis more specified type of cost effectiveanalysis. This analysis considers Quality adjusted life years (QALY) as itsefficacy parameter. This method is most commonly used in Cancer.
In this methodQALY is compared to that of the cost incurred to treat the cancer patients. Sothis method not only measures Quantity i.e., number of years of survival butalso measures the Quality of life in those years lived. These studies are ofutmost importance in newer treatments which do not increase the years of survivalbut aimed in increasing the Quality of life in cancer.
The Cost benefitanalysis is the least preferred type ofPharmacoeconomic analysis. This considers both the cost and efficacy inmonetary terms to assess the cost benefit ratio between the two. It is verydifficult to convert the efficacy parameter like number of years lived by aperson in to monitory terms. This makes it a less popular method in analyzingPharmacoeconomics (Borghi, 2007).
DIFFERENT PERSPECTIVESOF PHARMACOECONOMICS:Thereare many international guidelines, which are framed for proper Pharmacoeconomicpractice globally. Most popular among these are ISPOR, and NICE. These two areadvisory in nature and work independently. The ISPOR deals the issues relatedto Pharmacoeconomics globally, where as the NICE work as advisory committee forNHS (UK).ISPOR(International society for Pharmacoeconomic and outcome research) is anon-profit organization dealing with both Pharmacoeconomics and outcomeresearch. It has about 90 member countries including India. This is anindependent committee which deals with the issues in Pharmacoeconomics.
Itprovides a forum for discussion about Pharmacoeconomics among differentdisciplines like healthcare sector, patients, regulators etc. It guides in framingthe policy or regulations in conduct of Pharmacoeconomic studies in its membercountries. Among the most of the studiesdiscussed in ISPOR forum in relation to cancer the Cost-Utility study is usedto measure Healtheconomics (ISPOR, 2008). NICEis an advisory committee for National health services of UK.
It takes in toconsideration of both efficacy and cost of the treatment to be used in NHS. TheNICE plays an important role in approval of new drugs for use in NHS. In caseof Cancer it compares the number of years of Quality adjusted years to that ofcost incurred to treat the patients.
CASE STUDYTheSavient Pharmaceutical Inc. has done Pharmacoeconomic study on drugs used forweight gain in cancer patients. This is a cost effective study to analyze thecost effectiveness of Oxandrolone with that of Megestrol Acetate or withPlacebo. Dr.
Hatoum and team have conducted this study in Chicago. Thestudy was done to understand the cost savings that can be done during treatingweight loss in cancer patients. The study consists of three arms.
First armtreated with the Oxandrolone, second arm treated with Megestrol where as thethird arm is treated with Placebo for a duration of four months. The cost forthe treatment taken for analysis includes the cost of the drug, Hospitalizationcost and cost taken for long term care are taken. The efficacy parameter takento compare these treatments was change in Body Mass Index (BMI).
Afterfour months of the study it was found that the cost incurred for treatment ofweight loss with Oxandrolone was $8,727, Mejestrol is $12,668 and for placebois $14,937 taking in to consideration of even Hospitalization cost. Theefficacy parameter taken is the change in the BMI after treatment. The numberof lives saved is 3.18, 4.72, and 1.54 respectively for Oxandrolone, Mejestroland placebo per 1000 patients. Sothe above study clearly shows that the Oxandrolone is more Cost Effective thanother treatments taken.
The yearly burden due to cancer is more than 150 billiondollars of which 40 to 50% of economic burden is due to weight loss leading tohospitalization in US. This Pharmacoeconomic model is very useful in predictingthe economic consequences of treatment of weight loss in cancer. CRITICAL EVALUATIONThetreatment of weight loss accounts for about 40-50% of the cost incurred totreat cancer. This is a huge economic burden for the country. The above studydiscussed is a cost effective study done to determine treatment which is hasboth efficacy and also economic for treating weight loss in Cancer patients.
The study is well planned in terms of design. It has even included the Placeboin its study to remove the placebo effect. This Pharmacoeconomic model can beapplied to even in other diseases to assess the most economic treatment. Though the Pharmacoeconomic model used in thiscase is very well planned in terms of study design, it has drawback inselection of efficacy and safety parameter.
This study considers only thechange in Basal Metabolic Rate but fails to realize that the major problem withcancer patients is Quality adjusted life years. Treatment which has effect onBMI alone cannot be considered to efficient treatment. Even the improvement inQALY is necessary for a treatment to be called efficient in case of Cancer. Sothe study should compare the cost with that of QALY of the cancer patientstreated for weight loss. The study is conducted only for a period of fourmonths that is too small period in assessing the cost effectiveness of thedrugs used in Cancer.
Overall,the study is well designed but lacks in some efficacy and safety parameterslike QALY. The study conducted is Cost effectiveness study. The Cost utilitystudy would be more beneficial in conditions like Cancer where both efficacyand Quality of life has equal importance. The Pharmacoeconomic model used canbe made robust by making little modification as mentioned above which canreally reduce the economic burden to the nation.CONCLUSIONPharmacoeconomicsis gaining increased importance globally. It is still primitive in developingcountries like India. It is really necessary to explore in to morePharmacoeconomic models which can decrease the economic burden withoutcompromising the efficacy and safety of treatments.
The present methods usedhave to be modified in to better models. The organizations like ISPOR and NICEare working really hard towards this still need complete support from both thePharmaceutical Industry and Government body.