Pharmacoeconomics and Safe Medication Use
There are several types of full economic evaluation. The main difference between the types of full
economic evaluation is how the benefits to the individual are measured and valued.
Compares only cost (i.e., no effectiveness) of two or more treatments or services
Potentially more applicable than cost-minimization analysis when effectiveness is not known
Cost-benefit analysis
Systematic approach assessing strengths and weaknesses of treatments or programs to determine
the best approach to attaining benefits while minimizing expense
Both costs and outcomes are measured in monetary units, including direct and indirect benefits,
allowing for a direct comparison.
Identifies yield of investment (e.g., justification of post-ICU clinic, comparison of a pharmacokinetics
service with a vaccination program)
| d. | Results may be expressed with cost-benefit ratio, net cost, or net benefit. |
|---|
Cost-effectiveness analysis
Compares two or more treatment alternatives or programs in which resources (e.g., treatments,
services) are used
Costs are measured in monetary terms, whereas outcomes are measured in units of effectiveness.
Determines which alternative can produce the desired effect or maximization of effect, which may
by a more expensive option that provides a more desirable outcome than a less expensive option
| d. | Results are expressed as the incremental cost-effectiveness ratio (ICER), which is defined as the |
|---|
additional cost to the next most effective intervention producing another unit of output. These results
can be displayed in a cost-effectiveness plane, which graphs the ICER in four quadrants (x-axis is
effectiveness; y-axis is cost).
Cost-minimization analysis
Compares two or more treatment alternatives or programs for which the outcomes are virtually
identical (e.g., effectiveness) except for costs; therefore, results are expressed in monetary form,
which allows for ease in examining resource outcomes
Costs are compared to determine the least expensive alternative with a noninferior efficacy.
Should not be used if no evidence supports the therapeutic equivalence of the treatment alternative
Cost-utility analysis
Comparison of two or more treatment alternatives or programs in which costs are measured in
monetary terms and outcome is expressed with respect to patient preferences, quality of life, or
quality-adjusted life-years (QALYs)
Form of cost-effectiveness analysis in which values (utilities) are assigned to the outcome
ii.
Life and death are reference states for the utilities, with perfect health = 1.0 and death = 0.0
(although to a patient, a certain state [e.g., vegetative] may be worse than death, allowing for a
negative utility).
iii.
Utilities or a patient’s preference for a disease state can be measured by obtaining information
from the literature, approaching a convenience sample of experts, using decision theory with a
direct approach, or using psychometric methods with indirect approaches.
| (a) | Direct approaches include rating scales, time trade-off (acute and chronic conditions), and |
|---|
standard gamble (acute and chronic conditions).
| (b) | Indirect approaches include multi-attribute health state scores (e.g., quality-of-life |
|---|
assessment tools).
To calculate QALYs, the life-years gained is determined and then multiplied by the utility of that
life-year. For example, if persons have a life expectancy of 20 years but have a disability and believe
they are functioning at only 70% of their capacity, the QALY is 20 years × 0.7 = 14 QALYs.
Measures the function and overall well-being of patients using quality-of-life assessment tools, such
as those used in the ICU, which are general and/or disease-specific (e.g., EuroQol 5D Questionnaire,
European Organization for Research and Treatment of Cancer 8 Dimensions)