Pharmacoeconomics and Safe Medication Use
aAndexanet = coagulation factor Xa (recombinant), inactivated-zhzo.
4F-PCC = 4-factor prothrombin complex concentrate; QALY = quality-adjusted life-year.
Modified from: Drummond MF, Sculpher MJ, Claxton K, et al. Methods for the Economic Evaluation of Health Care Programmes, 4th ed. Oxford University Press, 2015.
Economic
Evaluation
Cost
Measurement
Consequences or Outcomes
Measurement/Valuation
of Consequence or
Outcomes
Example
Challenges
Cost analysis
(partial
evaluation)
Monetary
Not considered, so not a full
economic evaluation
Not considered, so not a
full economic evaluation
Cost of cisatracurium compared
with rocuronium in patients with
acute respiratory distress syndrome
(disregarding any outcome)
Challenges limited
compared with
CUA
Cost-benefit
analysis
(CBA)
Monetary for
total cost of
care
Single or multiple effect/outcome
that does not have to be common
to both alternatives
Effects are translated to monetary
units, so comparison among
various alternatives is possible
Monetary units
Comparison of pharmacist-led
blood factor prescription with
standard of care on andexanet costs
to hospital
Translating
consequences to
monetary units
Cost-
effectiveness
analysis
(CEA)
Monetary for
total cost of
care
Must have a single effect/outcome
of interest for all alternatives
considered, and the effect/outcome
is achieved to a different degree
The outcomes of the alternative
strategies are not equivalent and
are measured in unidirectional
natural units
Nonmonetary physical
units of effectiveness.
(e.g., life-years gained,
surrogate end point)
Comparison of andexanet with
4F-PCC on bleeding-related
mortality
Determining the
probabilities of the
clinical pathway
for the decision
tree to determine
the consequences
Cost-
minimization
analysis
(CMA)
Monetary for
total cost of
care
Must be evaluated
Single effect/outcome of interest
for all alternatives that were shown
to be equivalent
Identical
Comparison of medication and
its biosimilar on cost because
equivalent outcomes are assumed
Proving
consequences are
identical
Cost-utility
analysis
(CUA)
Monetary for
total cost of
care
Single or multiple effect/outcome
that does not have to be common
to both alternatives
Effects are translated to QALYs,
so comparison among various
alternatives is possible
Utility values and QALYs
Comparison of andexanet with
4F-PCC on patient outcomes,
measured by patient utility (QALY)
Measuring utilities