The University of Florida College of Pharmacy
Department of Pharmaceutical Outcomes & Policy
PHA 5267: Critical Appraisal of Pharmacoeconomic Studies
POP GRADUATE STUDENT SECTION
Spring 2011
Friday 10:40 – 12:35pm
Communicore C1-11
Course Coordinator & Instructor:
Teresa L. Kauf, Ph.D., Associate Professor
Office: HPNP 3338
Phone: (352) 273-6252
Email: tkauf@ufl.edu
Office Hours: Combined office hours and question & answer sessions will be held via
Elluminate on Wednesdays from 3 – 4:00pm (see below for more information). Otherwise,
please email or phone to make an appointment.
Course Description:
A variety of technological and environmental factors are fueling continued increases in health
care expenditures, including pharmaceuticals, in the United States and elsewhere. As a result,
both public and private payers of health care have instituted various measures of cost
containment, including the economic evaluation of pharmaceuticals, commonly referred to as
“Pharmacoeconomics”. In this course, we will review decision making tools such as costeffectiveness and cost-benefit analysis and discuss their application to resource allocation, how
these tools are used in practice, and what factors limit their use or interpretation.
Why is this course important? Pharmacoeconomics techniques are becoming increasingly
common in the medical and health outcomes literature and as a tool for health care decision
making. Pharmacists, through their influence on drug therapy selection, must understand the
tools of pharmacoeconomics so that such decisions will be made appropriately.
Pharmacoeconomics is an important field of research within the pharmaceutical industry and the
larger health care industry, and there are many career opportunities for pharmacists who wish to
specialize in this field.
Credit Hours = 1
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Course Objectives:
The primary objective of this course is to (1) introduce students to the fundamental methods of
pharmacoeconomic analysis and (2) prepare them to read and interpret pharmacoeconomic
studies. By the end of this course, students should have a working understanding of the tools
for economic evaluation of pharmaceuticals and their use in decision making, including the
following:




Fundamental concepts behind rationing and economic evaluation of health care;
The role of pharmacoeconomics in the drug development process and health care
decision making;
Strengths and weaknesses of standard pharmacoeconomic approaches available to
assess the economic impact of pharmaceutical interventions, including costeffectiveness analysis, cost-utility analysis, cost-benefit analysis, and cost-minimization
analysis; and
The role of perspective in the selection of study parameters and their impact on study
design, costs, and the interpretation of results.
Students will be prepared to policy recommendations based on pharmacoeconomic information
and constructively participate in the debate on health care rationing.
Teaching Methods and Course Structure:
This class will meet for 100 minutes on Fridays during 4th and 5th periods (10:40am – 12:35pm)
for seven (7) weeks, beginning Friday, January 7, 2010. Attendance at the live lectures is
encouraged, but not mandatory.
Live lectures will employ the TurningPoint Classroom Student Response System (“clickers”).
The clickers will be used in class to actively engage professional students through the use of
general polling during discussions to gauge understanding of the material. Clickers will not be
used for quizzes or other graded work. Graduate students are not required to purchase
clickers for this course, although they are welcome to do so. For information on clickers,
please visit the UF student guide on the TurningPoint ResponseCard RF Remotes.
The final exam will be held on Thursday, February 24, 2010 from 4 – 6pm (Gainesville rooms
TBD).
Combined office hour and review sessions will be held via Elluminate on Wednesdays from 3 –
4pm, beginning January 12. These sessions will be recorded for students to view at a later
date. Students may submit questions ahead of time to the instructor. Please email questions to
kauf@cop.ufl.edu by noon the day of the session.
Before joining an Elluminate session for the first time, please review this information. Point your
browser to the UF Elluminate website at
http://elm.elluminate.com/UniversityOfFlorida/index.html to sign in to meetings and view
recorded meetings. Hint: use the search box to search for “PHA5267 Instructor Office Hours”
to find the meeting. Or, you can point your browser directly to
http://elm.elluminate.com/UniversityOfFlorida/join_meeting.html?meetingId=1247979228002.
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Course Text and Resources:
There is no required text for the course. No background knowledge of economics is necessary;
however, some familiarity with basic economic principles such as supply and demand and
marginal analysis will be helpful. If you are concerned about your preparation for this class,
please contact the instructor.
For those students who desire some background information prior to lecture, optional readings
will be posted for each class. There are several introductory texts that cover the topics that will
be discussed in the course; Essentials of Pharmacoeconomics, First Edition, by Karen L.
Rascati (Philadelphia, PA: Wolters Kluwer, 2009) is recommended as a reference for students
who would like additional practice. Relevant chapters from Rascati are listed in the Course
Schedule but will NOT be posted to ELS due to copyright issues (with the exception of Chapter
3 which will be posted).
If you are particularly interested in pharmacoeconomics and plan to take PHA6264 next year,
you might consider purchasing a textbook for that class now. Although subject to change, the
most recent textbook for the course is Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ,
Stoddart GL. Methods for the Economic Evaluation of Health Care Programmes. Third Edition.
Oxford University Press, 2005. There are a variety of other useful texts; please see the
instructor to discuss which might best suit your needs.
Some lectures will include content from published pharmacoeconomic analyses or related work,
and these articles are required. In addition, a portion of the assignments for the class will rely
on published articles. All required readings are listed in the Course Schedule and will be posted
on ELS.
Students without prior experience conducting literature searches in the area of
pharmacoeconomics should read the module, “Searching the Published Economic Evaluation
Literature,” and complete the exercise that follows it. Completion of the module and the
associated exercise is completely voluntary and does not contribute directly to students’ grades.
However, understanding where and how to look for pharmacoeconomic information may be
helpful for completing course assignments. The module, the accompanying exercise, and an
answer key are posted on the course website and can be completed at your leisure.
Evaluation Techniques:
Grades in this course will be based on weekly exercises, weekly current events discussion
sessions (last 5 weeks of the semester only), a review paper, and a final exam as described
below. All of the assignments will be posted on ELS.
Weekly Exercises
Weekly exercises will be posted on ELS after most lectures, for a total of five exercises. These
individual assignments are designed to assess your understanding of the material covered in
class and in the readings. At least some questions for each week’s assignment will draw upon
a published pharmacoeconomic article. The exercises will be similar to those given to the
professional students, but will be slightly more in-depth.
Current Events Discussions
Graduate students will meet with the instructor for an informal discussion of current events
every Friday from 2 – 3pm, beginning on March 18 and ending on April 15, for a total of 5
sessions. The purpose of these sessions is to encourage students to consider the broader
implications and applications of technology assessment.
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Each graduate student shall identify a news item that is related to pharmacoeconomics and
health technology assessment (either directly or indirectly). Items should be current (within the
past 6 months) and should come from the general news media, not from scientific or
professional journals. Students will provide a short (oral) introduction and then the implications
of the piece will be discussed by the group. Finally, each student will submit a brief write-up
summarizing the article and its implications. Detailed instructions are provided on ELS.
Review Paper
The final project for PHA5267 is a review paper that will build on the project proposals
developed in the Intro to POP course, PHA6266. The objective of the paper is to establish the
economic significance of your Intro to POP project by critically analyzing and interpreting the
pharmacoeconomic literature related to it. For some topics, the economic implications will be
relatively straightforward. In other cases, you may need to put some thought into it. Rest
assured, if you can make a case that your topic is significant, that significance can be
extrapolated into an economic argument. If you need help, come see me, and we’ll come up
with something together.
One purpose of this exercise is to practice describing the significance and value of your work.
The other chief purpose of the project is to develop your critical appraisal skills. Your review of
the existing pharmacoeconomic literature should recognize areas of general consensus or lack
thereof and identify gaps in the literature.
There are no page limits for this exercise. I imagine that most of your reports will be around 5
double-spaced pages, not counting references, tables, etc. Importantly, every statement in your
paper should be written towards some purpose; that is, extraneous content that is not directly
related to the exercise should be excluded. It may be useful to consult some general reviews of
cost-effectiveness literature—even if outside your project area—to get a sense of how they are
written and the types of information included in them. The journal, Pharmacoeconomics,
publishes systematic reviews on a fairly regular basis.
The review paper is due by 5pm on Friday, April 22.
Final Exam
Graduate students will take the same final exam as the professional students. The final exam
will consist of multiple choice and true/false questions and will be held from 4 – 6pm on
Thursday, 24 February 2011. The exam will cover all material presented in lecture, weekly
exercises, and assigned readings.
Grading Summary:
Course grades will be determined as follows:
Assignment
Weekly Exercises
Current Events Write-Up and Participation
Review Paper
Final Exam
Total
4
Contribution
40% (5 exercises @ 8% each)
10%
25%
25%
100%
Scores from each of the assignments will be combined to calculate the final grade. Letter
grades will be assigned according to the following scheme*:
A:
B+:
B:
C+:
C:
D+:
D:
E:
90.0 – 100%
87.0 – 89.9
80.0 – 86.9
77.0 – 79.9
70.0 – 76.9
67.0 – 69.9
60.0 – 66.9
<60
* In accordance with the Faculty Senate resolution of December 14, 2006, the University of Florida’s grading scale
will be changed to include minus grades effective the Summer 2009 term. To see the comparative chart depicting the
changes to the official grading scale, see http://www.isis.ufl.edu/minusgrades.html or go to
http://www.registrar.ufl.edu/catalog/policies/regulationgrades.html for more information.
Late Assignment Policy
All assignments are due by 5:00 pm Gainesville time on the due date specified in the course
schedule. Late assignments that are submitted prior to the discussion of answers or publication
of an answer key will receive one of the following:


The class mean if the actual score is the mean or higher, or
The actual score if the score is lower than the class mean.*
Delays due to unforeseen and distressing events (e.g., serious illness, a death in the family,
hardware/software failure) will be treated on a case-by-case basis by the instructor. Any
assignment submitted after the publication of an answer key or discussion in class will receive a
zero score, NO EXCEPTIONS.
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Academic Honesty:
The conduct of all students is expected to conform to the standards of academic integrity as
described in the University of Florida Honor Code. In adopting this Honor Code, the students of
the University of Florida recognize that academic honesty and integrity are fundamental values
of the University community. Students who enroll at the University commit to holding themselves
and their peers to the high standard of honor required by the Honor Code. Any individual who
becomes aware of a violation of the Honor Code is bound by honor to take corrective action.
Student and faculty support are crucial to the success of the Honor Code. The quality of a
University of Florida education is dependent upon the community acceptance and enforcement
of the Honor Code.
The University of Florida Honor Code
“We, the members of the University of Florida community, pledge to hold ourselves and our
peers to the highest standards of honesty and integrity.”
On all work submitted for credit by students at the University of Florida, the following pledge is
either required or implied:
“On my honor, I have neither given nor received unauthorized aid in doing this assignment.”
Students should be aware that any use of resources other than those explicitly allowed on an
assignment will be considered as academic dishonesty. Plagiarism, which occurs when another
person’s work is used or copied without attribution, also will be considered academic
dishonesty. All incidents of demonstrated or suspected academic dishonesty will be reported to
the Associate Dean for Professional Affairs, and procedures regarding academic dishonesty will
be enforced. Students who fail to apply a high level of academic integrity to all conduct related
to this course risk receiving a failing grade.
For more information about academic honesty and the University of Florida’s Honor Code, point
your browser to the Dean of Students Office and Student Judicial Affairs at
http://www.dso.ufl.edu/judicial/procedures/studenthonorcode.php.
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Communication with Faculty:
ELS will be used for most communications between the faculty and students. Check for new
announcements at least once a day for any course updates. Email will also be used once in a
while for mass communication to the class, so please check your email at least once a day as
well. All emails sent out to the entire class will also be posted as an announcement on ELS.
General questions about course content or policies should be posted to the discussion board.
Students are expected to help each other track down answers as best as possible. When
needed, the instructor and/or TAs will respond to posts. Just be sure you are not giving
answers to any assignments as this is potential grounds for academic dishonesty. Read
through all the other posts in the discussion board first before posting to make sure your
question has not been addressed/answered already. Please include clear subjects for your post
topics to make the subject your post pertains to clear to others.
Discussion board postings and emails can easily be misinterpreted, so make sure your
message is clear before sending it. Any posts/emails deemed inappropriate by the instructor
and/or TAs will be dealt with on a case-by-case basis directly with the instructor or the Associate
Dean for Professional Affairs.
For personal issues/questions, please email the TA or the instructor directly. Be sure to include
in the subject line the course number and a brief description (e.g., PHA5267 – Family
emergency). This will allow coordinators to easily identify emails related to the course in
amongst the plethora of junk and other emails that are received each day. Emails not properly
addressed may get lost in the shuffle and unintentionally deleted or ignored, so be sure to follow
the guidelines exactly.
Accommodations for Students with Disabilities:
Students requesting classroom accommodation must first register with the Dean of Students
Office. The Dean of Students Office will provide documentation to the student who must then
provide this documentation to the course instructor when requesting accommodation. Request
for accommodation should be made at the beginning of the semester for exams or other
assignments due during the semester.
Faculty and Course Evaluations:
Course and instructor evaluations are requirements for the successful completion of this course.
Course and instructor evaluations must be completed, just as exams, papers, and assignments
must be completed for you to receive credit for this course and all other courses in the College
of Pharmacy. If you do not complete all required course and instructor evaluations by the last
day of classes, you will receive an "I" or an incomplete grade for the semester because you
have not completed all of the course requirements. See the College of Pharmacy
Student/Faculty handbook and the UF undergraduate catalog in the Academic Regulations
Section regarding policies and procedures for the conversion of "I" grades.
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Course Schedule:
Date
Topic
Readings
Assignments*
Course Overview & Introduction to
Pharmacoeconomics
Week 1
Jan 7
Required: Ubel & Goold (1998)—pp 209 –
210 only, Rascati Chapter 3
Optional: Rascati Chapter 1 or
Bungay & Sanchez (2003)
Measuring and Estimating Costs
Week 2
Jan 14
Optional: Rascati Chapter 2 or
Robertson et al (2003)
Cost Effectiveness Analysis
Week 3
Jan 21
Required: Doubilet et al (1986)
Weekly Exercise 1: Costs
Due Jan 20
Optional: Rascati Chapter 5 or
Eisenberg (1989)
Health-Related Quality of Life
Week 4
Jan 28
Optional: Rascati Chapter 8 or Guyatt et al
(1993)
Weekly Exercise 2: CEA
Due Jan 27
Cost Utility Analysis
Week 5
Feb 4
Optional: Rascati Chapter 6 or Naglie et al
(1997)—skip probabilities section
Weekly Exercise 3: QOL
Due Feb 3
Decision Analysis
Week 6
Feb 11
Optional: Rascati Chapter 9 or Detsky et al
(1997a, b)—just skim the second paper—or
Briggs & Sculpher (1998)—skip sections 2.4
– 3)
Weekly Exercise 4: CUA
Due Feb 10
Cost Benefit Analysis, Net Monetary Benefit,
and Sensitivity Analysis
Week 7
Feb 18
Optional: Rascati Chapter 7 (skip bidding
vehicles and IRR) or Hoch et al (2002)—just
the introduction—or Briggs et al (1994)
Week 8
Thurs, Feb 24
FINAL EXAM: 4 – 6:00pm. Rooms TBD.
Week 11
Mar 18
Current Events Session
Weekly Exercise 5: Dec Trees
Due Feb 17
Evelyn, Jessica, Jean
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Date
Topic
Readings
Week 12
Mar 18
Current Events Session
Xinyue, Monica, Hong
Week 13
Mar 18
Current Events Session
Salvatore, Amy, Danny
Week 14
Mar 18
Current Events Session
Wei, Hanah, Steven
Week 15
Apr 15
Current Events Session
Danijela, Irene, TBD
Week 16
Apr 22
REVIEW PAPERS DUE: 5pm
Assignments*
* Weekly exercises are due by 5:00pm ET on the Thursday before class.
Course Bibliography:
Bond CA, Raehl CL. Clinical and economic outcomes of pharmacist-managed aminoglycoside
or vancomycin therapy. Am J Health Syst Pharm. 2005 Aug 1;62(15):1596-605. Week 3
REQUIRED.
Briggs A, Sculpher M, Buxton M. Uncertainty in the economic evaluation of health care
technologies: The role of sensitivity analysis. Health Econ. 1994;3(2):95-104.
Briggs A, Sculpher M. An introduction to Markov modeling for economic evaluation.
PharmacoEconomics. 1998; 13(4): 397-409.
Bungay KM, Sanchez LA. Types of economic and humanistic outcomes assessments. In:
Pharmacoeconomics & Outcomes, 2nd Edition. 2003. Kansas City, MO: American College of
Clinical Pharmacy.
Detsky AS, Naglie G, Krahn MD, Naimark D, Redelmeier DA. Primer on medical decision
analysis: Part 1—Getting started. Med Decis Making. 1997a Apr-Jun;17(2):123-5.
Detsky AS, Naglie G, Krahn MD, Redelmeier DA, Naimark D. Primer on medical decision
analysis: Part 2—Building a tree. Med Decis Making. 1997b Apr-Jun;17(2):126-35.
Doubilet P, Weinstein MC, McNeil BJ. Use and misuse of the term “cost-effective” in medicine.
New Eng J Med (1986); 314(4): 253-6.
Eisenberg JM. Clinical economics: A guide to the economic analysis of clinical practices. JAMA
1989; 262(20):2879-86.
Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med.
1993 Apr 15;118(8):622-9.
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Hoch JS, Briggs AH, Willan AR. Something old, something new, something borrowed,
something blue: A framework for the marriage of health econometrics and cost-effectiveness
Health Econ. 2002; 11 (5): 415-30.
Hughes DA, Vilar FJ, Ward CC et al. Cost-effectiveness analysis of HLA B*5701 genotyping in
preventing abacavir hypersensitivity. Pharmacogenetics. 2004 June;14(6):335-342. Week 6
REQUIRED.
Khalid AN, Quraishi SA, Hollenbeak CS, Stack BC Jr. Fine-needle aspiration biopsy versus
ultrasound-guided fine-needle aspiration biopsy: cost-effectiveness as a frontline diagnostic
modality for solitary thyroid nodules. Head Neck. 2008 Aug;30(8):1035-9. Week 5 REQUIRED.
Mark DB, Hlatky MA, Califf RM et al. Cost effectiveness of thrombolytic therapy with tissue
plasminogen activator as compared with streptokinase for acute myocardial infarction. New
Engl J Med. 1995; 332(21):1418-24. Week 4 REQUIRED.
Naglie G, Krahn MD, Naimark D, Redelmeier DA, Detsky AS. Primer on medical decision
analysis: Part 3—Estimating probabilities and utilities. Med Decis Making. 1997 AprJun;17(2):136-41.
Robertson J, Lang D, Hill S. Use of pharmacoeconomics in prescribing research. Part 1: costs-moving beyond the acquisition price for drugs. J Clin Pharm Ther. 2003 Feb;28(1):73-9.
Sullivan PW, Arant TW, Ellis SL, Ulrich H. The Cost Effectiveness of Anticoagulation
Management Services for Patients with Atrial Fibrillation and at High Risk of Stroke in the US.
Pharmacoeconomics. 2006;24(10):1021-33. Week 7 REQUIRED.
Ubel PA, Goold SD. ‘Rationing’ health care: Not all definitions are created equal. Archives Int
Med 1998; 158(3):209-14.
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