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