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Pharmacoeconomics
PP4 Pharmacoecnomics and Med Formulary
| Question | Answer |
|---|---|
| Why is medicine use governed? | To manage the clinical risk to the patient and the financial risk to the institution |
| What is assessed about new drugs before they are able to be added to the formulary? | Safe with an acceptable toxicity profile No harm to the patient Efficacious: Does it work? Is it better than currently available treatments? If so, by how much? How much does this extra benefit cost? |
| Public hospitals do not make a profit, how is the financial risk for medications managed? | Drug technologies are getting more sophisticated Sophisticated = expensive ! (Sponsor R&D) Cancer treatments alone, PBS spent an addition 200 million from 12/13 FY to 13/14 Demand to want to use them Disease surveillance |
| How much money was spent on medications for FY 2016/2017 by the PBS? | 12.1 billion dollars, increase of 11.3% on previous FY |
| How much money was spent on medicines by the WA DOH for the FY 2016/2017? | 307 million dollars, 15.7% increase on last FY |
| What is health economics? | Integrates economics and medicines More than affordability Apply economic concepts to funding decisions Limited resources (Public Health system) Opportunity cost and resource allocation |
| How are medications governed in the hosital setting? | A medication Formulary: List of approved medications available to prescribers for initiation in a health service Applying principles of health economics to clinical decision making |
| Why have a medicines formulary? | The gold standard of medication governance - WHO -Nationally In Australia, approach differs across state / jurisdiction |
| Explain the medication governance structure in WA | Top: director general, then the state health executive forum, then the chief medical officer, then the WA therapeutics advisory group, then the wa drug evaluation panel. |
| What are the different branches from the WA drug evaluation panel? | Procurement, medication safety committtees, drugs and therapeutics committee, formulary development team, Committees for antimicrobials, psychotropics, clinical ntworks, expert advisory groups. |
| What are the principles of a good medication formulary? | Dynamic Understating trends in evidence and change restrictions accordingly = Horizon scanning Support appropriate physician autonomy Individual hospital Drugs and Therapeutics Committees (DTCs) Prescribing versus dispensing formulary |
| What are the key roles of the medicines formulary? | Support efficienies in the management of medicine use Make HR more efficient by reducing duplicate processes that use a lot of resources Make listing and prescribing more uniform and transparent Single medicines formulary for Electronic med management |
| What are the remaining roles of the formulary? | Serve clinicians, patients and health services Increase opportunity for efficient procurement and negotiation with sponsors Increase opportunity for monitoring, reporting and review of medicine use |
| Outline the WA State Medicine Formulary | Formulary for whole state, restriction levels (cohot, indication, specialists, centres/site), local/statewide guidelines, cost effectiveness initations where appropriate, product mims and pbs info, library services, on portable devices, imprest info |
| How is the WA SMF governed? | WA drug evaluation panel governs and manages, reviews new drug submission and amendedments Local DTC reviews individual patient approval requests and local med management guidelines PBAC: recommends new drugs for PBS based on cost-effectiveness |
| What is the role of the Drugs and Therapeutics Committee (DTC)? | Link between WADEP and hospitals Manage and govern system that allows for outside formulary prescribing for approved indications Individual patient approval Audit drug use (drug usage evaluation) |
| What is taken into consideration when evaluating an Individual Patient Approval request? | Are there other formulary alternatives available: Treatment failure or intolerance How is response / outcome measured? How long will treatment be needed? Non drug cost savings: Length of stay ,Reduced hospitalisation |
| How is the SMF monitored and reviewed? | Drug Usage Evaluation (DTC) Systemic review that determines if medicines are being used appropriately against formulary indication Can involve any aspect of the medication management cycle: dispensing, monitoring, prescribing, administration |
| What is drug usage evaluation? | Usually reactive (completed retrospectively) Can help identify gaps in practice Useful tool to help with formulary decisions: Has there been a change in evidence ? Is a clinical guideline or a treatment algorithm required |
| What resources are used for drug usage evaluation? | Patient notes, dispensing data, blood tests |
| How does the PBS apply to the SMF? | PBS is formulary - doesn't change fast enough in practice Role has changed in recent years PBS not always appropriate for hospital setting Pharmaceutical hospital reform: state v fed funding PBS drugs cannot always be claimed PBAC decisions |
| How is cost in health care managed? | Measures the overall cost of the intervention, not just the cost of the drug. example: hospital costs, health service costs like GP visits, adjunctive therapies, social costs like domestic help, diability allowance etc. Very hard to determine true cost |
| Who makes cost effective decisions in Australia? | PBAC WA Drug evaluation panel DTC |
| In the cost effective plan, what is a dominated intervention? | Less effective and more costly than existing treatment |
| In the cost effective plane what is a dominant intervention? | More effective and less costly than existing treatments |
| What is pharmacoeconomics? | Compares value of one drug to another Assists in assignment of resources, used to guide purchasing decisions. Used by policy makers, health professionals and clinical decision makers. |
| Why is pharmacoeconomics used? | Policy and program development and allocation of resources |
| What are some of the methods used to measure cost-effectiveness? | Compare drug cost with outcome (a costs less than b and has same outcome -generics) Measure outcomes of two alternative treatments against a utility (assesses quality of life measures) |
| What is a cost-utility analysis? | Outcomes of two alternative treatments are measured using a utility such as value/worth/QALYs. QALY measured disease burden, quality and quantity in 1 metric. Allows for comparison of different diseases. |
| What is the incremental cost effective ratio? | Used to compare effectiveness of a new drug to a comparator. Calculated by net cost/net effect Reported in monetary units as cost per health outcome. Usually expressed as cost per QALY. Cost/ QALY is main parameter used to make cost effectiveness decis. |
Created by:
LDM
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