Pharmacoeconomics

Pharmacoeconomics is the branch of economics that applies cost-benefit, cost-effectiveness, cost-minimization, and cost-utility analyses to compare the economics of different pharmaceutical products or to compare drug therapy to other treatments. Over the years, ICPD scientists have been involved with a variety of pharmacoeconomic studies, from varying perspectives, involving both ambulatory and hospitalized patients. Our analyses have been effectively utilized by clinicians, formulary committees, and pharmaceutical companies as a mechanism to discriminate between competing therapeutic alternatives.

One Recent Application

In the United States (US), costs of adverse drug event (ADE)-associated morbidity and mortality exceed $136 billion annually. ADE-related hospital admissions, prolonged hospitalizations, medical procedures and medicinal therapy are major contributors to these costs. Despite these observations, specific cost data associated with a given ADE category are limited.

ICPD scientists were the first to analyze clinical trial databases in an effort to gain better insight into the cost consequences of ADEs in total, and make comparisons across ADE categories. Through such analyses, we have demonstrated, across antimicrobial agents and classes, that differences in resource consumption exist, even within the same ADE category. The histogram below shows the probability versus cost per ADE from a well-controlled, randomized clinical trial comparing amoxicillin-clavulanate to gemifloxacin for the treatment of ambulatory patients with community-acquired pneumonia.

The results of this analysis can be used to estimate differences in resource consumption:

ADE-adjusted prescription cost = (cRx + (pADE x cADE)) x n

where cRx is the cost of a prescription, pADE is the probability of the adverse drug event requiring an intervention (ADE), cADE is the cost of an ADE, and n is the number of patients treated. Using the results of this analysis and assuming the mean cost of an ADE, the ADE-adjusted prescription cost per patients is:

amoxicillin-clavulanate: ($65 + (0.19 x $59.64)) x 1 = $76.33
gemifloxacin: ($65 + (0.084 x $59.64)) x 1 = $70.01

If physicians from a managed care organization wrote for 50,000 prescriptions for amoxicillin-clavulanate and 50,000 prescriptions for gemifloxacin, we would expect the managed care organization to pay $316,092 US (95% CI, $27,030-$605,154) more for amoxicillin-clavulanate than for gemifloxacin.

Finally, data such as these can also be utilized in stochastic models, which allow for improved patient-care decisions by health maintenance organizations, governmental agencies, formulary-decision makers, and clinicians.