Pharmacoeconomics

PHARMACOECONOMICS

1. PHARMACOECONOMICS Presented by- Dr. Aakanksha Priya, Dept. of Pharmacology, AIIMS, Patna.

2. OVERVIEW Introduction Definition of Pharmacoeconomics Methods of Pharmacoeconomics Cost effectiveness analysis Original article Conclusion Bibliography

3. INTRODUCTION Pharmacoeconomic research is the process of identifying, measuring, and comparing the costs, risks, and benefits of programs, services, or therapies and determining which alternative produces the best health outcome for the resource invested .

4. DEFINITION Pharmacoeconomics has been defined as the description and analysis of the cost of drug therapy to healthcare systems and society.

5. METHODS OF PHARMACOECONOMICS PHARMACOECONOMICS HUMANISTIC 1.Quality of life 2.Patient preferences 3.Patient satisfaction ECONOMIC 1.Cost benefit analysis 2. Cost effectiveness analysis 3.Cost minimization analysis 4.Cost utility analysis

6. ECONOMIC BASIS OF PHARMACOECONOMIC COST BENEFIT ANALYSIS- Cost-benefit analysis (CBA) is a method that allows for the identification, measurement, and comparison of the benefits and costs of a program or treatment alternative. COST MINIMIZATION ANALYSIS- Cost-minimization analysis (CMA) involves the determination of the least costly alternative when comparing two or more treatment alternatives. COST UTILITY ANALYSIS- Cost-utility analysis (CUA) is used to determine cost in terms of utilities, especially quantity and quality of life.

7. COST EFFECTIVENESS ANALYSIS Cost-Effectiveness Analysis (CEA) estimates the costs and health gains of alternative interventions . It is expressed in the form of 2 different ratios- Average cost-effectiveness ratio (ACER)- it represent the total cost of a treatment alternative divided by its clinical outcome to yield a ratio representing the rupees cost per specific clinical outcome gained, which are independent of comparators. ACER- health care cost( rs )/clinical outcome.

8. 2) Incremental Cost Effective Ratio(ICER)- It can be used to determine the additional cost and effectiveness gained when one treatment alternative is compared with the next best treatment alternative . ICER- Cost of A ( rs )- Cost of B ( rs )/ effect of A(%) – effect of B(%) Thus, CEA can provide valuable data to support drug policy, formulary management, and individual patient treatment decisions.

9. ORIGINAL RESEARCH ARTICLE TITLE- Pharmacoeconomic comparison of Losartan and Amlodipine in patients of hypertension in a tertiary care teaching hospital. STUDY CONDUCTED AT- Dept. of Pharmacology, Rohilkhand Medical College and Hospital, Bareilly, U.P. BACKGROUND- To conduct a pharmacoeconomic comparison (cost-effectiveness analysis) and to evaluate the overall safety and efficacy of Losartan and Amlodipine in reducing the Mean blood pressure per mm Hg in hypertensive patients.

10. INTRODUCTION According to several studies, Losartan 50mg and Amlodipine 5mg are equal in efficiency as anti-hypertensive as monotherapy. Main objective – to study, cost per mmHg reduction of Mean Blood Pressure and the cost per patients of achieving BP control along with comparing the overall efficacy and safety of the two antihypertensive agents.

11. METHODS It was a prospective, randomized, observational open label comparative clinical study of three months duration . Inclusive criteria’s- 1)Patients of age 18-65 years 2) both sexes 3) Newly diagnosed patients of hypertension were enrolled. Written informed Consent were taken before start of the study. Total of 80 patients were included who fulfilled all inclusive criteria.

12. CONT…. STEPS FOLLOWED – Demographic information were collected. Patient’s B.P was recorded by using mercury sphygmomanometer and stethoscope. A total 80 patients were divided into 2 groups. One group was treated with Losartan 50mg OD and other group received Amlodipine 5 mg OD. Patients under treatment were subsequently monitored and re-assessed at regular follow-ups for evaluation of BP reduction or control and monitoring of adverse effects.

13. CONT… For pharmacoeconomic evaluation, cost effectiveness analysis was done. Cost was expressed in term of currency in which it was bought. Effectiveness was taken as the average reduction in Mean BP and the percent of patients reaching the goal value (<140/90) with fixed dose schedule of antihypertensive in both the groups. The cost-effectiveness was calculated using incremental cost for per mmHg BP reduction. ICER= Cost of A- Cost of B / Effect of A – Effect of B.

14. RESULTS (AT BASELINE) LOSARTAN AMLODIPINE TOTAL No. of patients 40 40 80 Male 22 24 46 Female 18 16 34 Rural 17 18 35 Urban 23 22 45 Age mean±SD (years) 46.7±10.6 46.8±11.2 SBP, mean±SD (mmHg) 154.86±6.86 154.64±5.12 DBP, mean±SD (mmHg) 96.17±4.2 96.45±3.6 Mean, BMI mean±SD (Kg/m²) 21.24±1.46 20.84±1.22

15. MEAN SBP BETWEEN 2 GROUPS Mean BP±SD LST Mean BP±SD AMLO t- value df p- value Baseline 154.86±6.86 Baseline±154.64±5.12 0.1625 78 0.8713 not significant 1 st follow-up 149.34±5.24 1st follow-up 148.23±4.12 1.0532 78 0.2955 not significant 2 nd follow up 139.12±4.85 2 nd follow up 140.68±4.12 1.0532 78 0.1788 not significant 3 rd follow up 131.96±4.82 3 rd follow up 132.14±5.26 0.1596 78 0.8736 not significant P-value <0.0001 P- value <0.0001

16. MEAN DBP BETWEEN 2 GROUPS (mean BP±SD) LST ( Mean±SD ) Amlo T- value df P-value Baseline 96.17±4.2 Baseline 96.45±3.6 0.3201 78 0.7497 1 st follow up 89.24± 3.12 1 st follow up 90.28±2.12 1.7437 78 0.0851 2 nd follow up 85.72±3.14 2 nd follow up 86.68±2.42 1.5315 78 0.1297 3 rd follow up 80.94±3.64 3re follow up 81.12±2.228 0.2651 78 0.7917 P-value <0.0001 P-value <0.0001

17. DIFFERENCE BETWEEN MEAN BP(MBP) BETWEEN 2 REGIMEN. GROUPS MBP±SD BASELINE MBP±SD FINAL VISIT MEAN DIFFEREANCE±SD P-VALUE LST 115.73±3.84 97.94±4.16 17.79±0.32 0.4319 AMLO 115.84±3.96 98.12±4.42 17.72±0.46 0.4319

18. COST EFFECTIVENESS ANALYSIS OF TWO REGIMEN BASED ON MBP Drugs Total cost( rs )= Cost of 1 tab* no.of days consumed Average MBP(mmHg) %patients who achieved target BP(<140/90) Cost/mmHg MBP reduction Cost/target BP LST 1840(20*92) 17.79 80 103.42 23 AMLO 1012(11*92) 17.72 76 57.11 13.31

19. INCREMENTAL COST EFFECTIVENESS RATIO Paramet-ers LST AMLO Difference in cost Difference in effectiveness ICER Cost/mmHg MBP reduction 103.42 57.11 46.31 0.07 661.5 Average fall in MBP 17.79 17.72

20. Incremental Cost Effectiveness Ratio (ICER) value was calculated to be Rs.661.5, which implies that in the Losartan group to reduce the MBP by one mm Hg, additional cost of Rs 661.5 has to be paid by the patient. It can therefore be assumed that in cases of stage1 Hypertension, it is exclusively the drug price rather than the effectiveness/efficacy, which is more important determinant of cost-effectiveness.

21. ADVERSE DRUG EFFECTS Adverse effects (%) of patients LST group (%) of patients AMLO group Dizziness 3.5 1.2 Headache 1.5 0.9 Palpitation 1.0 2.2 G.I. upset 0.8 0.7 Cough 0.5 Emotional distress 1.0 0.8 Pedal oedema 0.6 10 Hot flushes 0.4 0.5

22. CONCLUSION Hence, the ICER indicated the most favorable cost-effectiveness outcome for Amlodipine with lower cost, effective control of BP with acceptable tolerability.

23. BIBLIOGRAPHY 1) Shaifali I, singh HK. Pharmacoeconomics comparison of losartan and amlodipine in patients of hypertension in a tertiary care teaching hospital.IJBCP:2017;6(3):552-557. 2) TRASK, LISA SANCHEZ.. "Chapter 1. Pharmacoeconomics: Principles, Methods, and Applications."  Pharmacotherapy: A Pathophysiologic Approach, 8e  Eds. Joseph T. DiPiro , et al. New York, NY: McGraw-Hill, 2011. 3)WHO