Drug-related morbidity and mortality: updating the cost-of-illness model.

OBJECTIVE: To update the 1995 estimate of $76.6 billion for the annual cost of drug-related morbidity and mortality resulting from drug-related problems (DRPs) in the ambulatory setting in the United States to reflect current treatment patterns and costs. DESIGN: For this study, we employed the decision-analytic model developed by Johnson and Bootman. We used the model's original design and probability data, but used updated cost estimates derived from the current medical and pharmaceutical literature. Sensitivity analyses were performed on cost data and on probability estimates. SETTING: Ambulatory care environment in the United States in the year 2000. PATIENTS AND OTHER PARTICIPANTS: A hypothetical cohort of ambulatory patients. MAIN OUTCOME MEASURES: Average cost of health care resources needed to manage DRPs. RESULTS: As estimated using the decision-tree model, the mean cost for a treatment failure was $977. For a new medical problem, the mean cost was $1,105, and the cost of a combined treatment failure and resulting new medical problem was $1,488. Overall, the cost of drug-related morbidity and mortality exceeded $177.4 billion in 2000. Hospital admissions accounted for nearly 70% ($121.5 billion) of total costs, followed by long-term-care admissions, which accounted for 18% ($32.8 billion). CONCLUSION: Since 1995, the costs associated with DRPs have more than doubled. Given the economic and medical burdens associated with DRPs, strategies for preventing drug-related morbidity and mortality are urgently needed.

Guidelines for performing a pharmacoeconomic analysis.

The fundamentals of pharmacoeconomics are presented. Pharmacoeconomic research is used to identify, measure, and compare the costs, risks, and benefits of programs, services, or therapies and determine which alternative produces the best health outcome for the resources invested. Each pharmacoeconomic method measures costs in monetary terms; the differences lie in the valuation of outcomes. In cost-minimization analysis, the outcomes are considered to be equal and therefore are not measured. Cost-benefit analysis measures outcomes in dollars, whereas cost-effectiveness analysis measures outcomes in nonmonetary units. In cost-utility analysis, outcomes expressed in nonmonetary units are adjusted for health-related quality of life. A well-designed pharmacoeconomic analysis involves 10 steps: (1) defining the problem, (2) determining the study's perspective, (3) determining the alternatives and outcomes, (4) selecting the appropriate pharmacoeconomic method, (5) placing monetary values on the outcomes, (6) identifying study resources, (7) establishing the probabilities of the outcomes, (8) applying decision analysis, (9) discounting costs or performing a sensitivity or incremental cost analysis, and (10) presenting the results, along with any limitations of the study. By adhering to the analytic steps described, the pharmacist undertaking a pharmacoeconomic evaluation has the greatest likelihood of obtaining valid and useful results.

Pharmacoeconomics of genetically engineered drugs.

Biotechnology is a rapidly developing area of drug development which has great growth potential. Development of genetically engineered drugs is very expensive and as these products become available the impact on healthcare costs could be vast. The cost-benefit ratio of biotechnology products needs to be established, but few relevant pharmacoeconomic studies are available. Issues in pharmacoeconomic analysis of genetically engineered drugs can be exemplified by the data available for alteplase, epoetin and interferon alpha-2b. One study concluded that thrombolysis with streptokinase rather than alteplase would substantially reduce the percentage of total hospital costs that were not reimbursed. However, differences in efficacy were not accounted for. Based on the superior efficacy of alteplase, a more extensive pharmacoeconomic analysis found that alteplase was more cost-effective than streptokinase when the agents were combined with aggressive reocclusion management. However, this conclusion may be altered by the finding of a more recent study that streptokinase may be at least as effective as alteplase. Economic factors involved in epoetin treatment of anaemia associated with chronic renal disease have been studied thoroughly. However, cost-effectiveness or cost-benefit analysis was not attempted, and improvement in quality of life with epoetin therapy also needs to be considered, to facilitate cost-utility analysis. Compared with chlorambucil, the use of interferon alpha-2b for hairy cell leukaemia resulted in significant direct and indirect cost savings, in a retrospective cost-benefit analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Economic analyses in hypertension: applications for healthcare providers.

Hypertension affects millions of Americans. With healthcare dollars becoming more closely scrutinized, economic studies are playing an important role in helping decision makers choose who should receive treatment and which treatments and methods of administration are most cost-effective. This article provides an overview of the different methods used in economic evaluation and demonstrates the utility of each method using studies from the hypertension literature.