Pharmaceutical Economics
Heng-Sim Lee RPh MS
Director of Pharmacy, ChiaYi Branch, Taichung Veterans General Hospital
Clinical Nutritional Pharmacist
Council Member of Taiwan Society of Parenteral and Enteral Nutrition (TSPEN)
Professional Representative of Parenteral and Enteral Nutrition Society of Asia (PENSA)
Council Member of Chia Yi city Pharmacist Association
Lecturer of Nursing Institute, Hung Kuang University
30th Nov. 2013
1952
1990
2003
Pharmaceutical Care
30th Nov. 2013
Hospital Pharmacists move closer to
Patient Care
Changes in Pharmacy Practice
What is Pharmaceutical Care?
The Pharmacist becomes more
specialised as a therapeutic advisor
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Pharmaceutical Care
Quality Assurance
of
Drug Therapy
Need
Goal
Process
Outcome
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Pharmaceutical care
‘’Pharmaceutical care is the direct,
responsible
• Cure
of the disease
Elimination or reduction
provision of medication-related care •forof
the
symptoms
• Arrest
purpose of achieving definite outcomes
thator slowing of a
disease process
improve a patient’s quality of life.’’ • Prevention of disease
or symptoms
Hepler CD and Strand LM (1990)
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Clinical Pharmacist
integrates into
medical specialties
Clinical Pharmacist
serves 60 beds
Pharmacist as
ward visitor
serves 120
beds
Emergence
of the
TeacherPractitioner
Community Pharmacy
Patient
Medication Records
Variety of
models
Pharmacy Patient
Computer Records
and Services to
Elderly Nursing
Homes
Primary Care
Pharmacy
Targeted Services
Innovations in Pharmacy Services
1970s
1980s
1990s
2000s
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Clinical Management Plan
Verifying
Treatment
Monitoring
Treatment
Confirming Outcomes
of Treatment
Transferring care
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Verification
Confirmation of
outcomes
Achievement of
Treatment Goals
Profile of Patient’s Characteristics
Patient Comprehension/Participation
Confirmation of Need
Drug History
Contra-indications/Interactions
Treatment Plan
Conformity to Guidelines
Confirmation of Safety
Unwanted Symptoms
Recorded
Adverse Reaction
Monitoring
Clinical Monitoring
Laboratory Markers
Adherence
to Treatment
Individualised Dose,
Dose Frequency,
Means of Administration
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Documentation
Pharmaceutical care plan
Responsibility
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History
• 1940~1960 Era of Expansion period
• 1970~1980 Era of Cost containment
• 1990~
Era of Assessment and
Accountability for Health Outcome
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Definition of Pharmacoeconomics
•
•
•
•
The process of identifying, measuring, and
comparing the costs, risks, and benefits of programs,
services, or therapies
To determine which alternative produces the best
health outcome for the resource invested
Most impactful when making decisions about a
population rather than individual
“Costs vs. Consequences of Alternatives”
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Micro to Macro Applications with
Board
Pharmacoecomomics From
Room to Bedside
Education in safe and effective prescribing practices. AAMC. July 2008.
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Perspective of Pharmacoeconomics
• Patient perspective
• Provider perspective
• Payer perspective
After selection of perspective
next step cost related
measurements
• Societal perspective
1.
2.
3.
4.
5.
6.
Direct medical costs
Direct non medical costs
Indirect nonmedical costs
Intangible costs
Opportunity costs
Incremental costs
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Application of Pharmacoeconomics
Drug Therapy Evaluation –
Selective the most cost-effective drugs for an organizational formulary
Making a decision about an individual patient’s therapy
Customizing a patient’s pharmacotherapy
Clinical Pharmacy Service Evaluation
•
•
•
•
•
•
•
•
•
•
Determining the value of an existing services
Estimating the potential worth of implementing a new service
Capturing the value of a “cognitive” clinical intervention
Industry-marketing pricing, performance guarantee
Managed care – protocols, guidelines, formularies
Physicians – individual patient treatment decisions, prescribing,
payer-performance
Consumer – education, autonomy
Government – pricing, approval, formularies, policy
Institution – protocol, guidelines, formularies
Pharmacist – formularies, protocol, guideline, pharmaceutical care
service or program evaluation
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30th Nov. 2013