1952 1990 2003

Pharmaceutical Economics

Heng-Sim Lee RPh MSDirector of Pharmacy, ChiaYi Branch, Taichung Veterans General Hospital

Clinical Nutritional Pharmacist

Council Member of Taiwan Society of Parenteral and Enteral Nutrition (TSPEN)

Professional Representative of Parenteral and Enteral Nutrition Society of Asia (PENSA)

Council Member of Chia Yi city Pharmacist Association

Lecturer of Nursing Institute, Hung Kuang University

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Pharmaceutical Care

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The Pharmacist becomes more The Pharmacist becomes more specialised as a therapeutic advisorspecialised as a therapeutic advisor

The Pharmacist becomes more The Pharmacist becomes more specialised as a therapeutic advisorspecialised as a therapeutic advisor

Hospital Pharmacists move closer to Hospital Pharmacists move closer to Patient CarePatient Care

Hospital Pharmacists move closer to Hospital Pharmacists move closer to Patient CarePatient Care

What is Pharmaceutical Care?What is Pharmaceutical Care?What is Pharmaceutical Care?What is Pharmaceutical Care?

Changes in Pharmacy PracticeChanges in Pharmacy PracticeChanges in Pharmacy PracticeChanges in Pharmacy Practice

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Pharmaceutical CarePharmaceutical CarePharmaceutical CarePharmaceutical Care

NeedNeed GoalGoal ProcessProcess OutcomeOutcomeNeedNeed GoalGoal ProcessProcess OutcomeOutcome

Quality Assurance Quality Assurance of of

Drug TherapyDrug Therapy

Quality Assurance Quality Assurance of of

Drug TherapyDrug Therapy

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Pharmaceutical care

‘’Pharmaceutical care is the direct, responsible

provision of medication-related care for the

purpose of achieving definite outcomes that

improve a patient’s quality of life.’’

• Cure of the diseaseCure of the disease• Elimination or reductionElimination or reduction of symptomsof symptoms• Arrest or slowing of aArrest or slowing of a disease processdisease process• Prevention of disease Prevention of disease or symptomsor symptoms

Hepler CD and Strand LM (1990)Hepler CD and Strand LM (1990)

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Clinical Pharmacist Clinical Pharmacist integrates into integrates into

medical specialtiesmedical specialties

Variety of Variety of modelsmodels

Innovations inInnovations in Pharmacy Pharmacy ServicesServices

Clinical Pharmacist Clinical Pharmacist serves 60 bedsserves 60 beds

Emergence Emergence of the of the

Teacher-Teacher-PractitionePractitione

rr

Pharmacist as Pharmacist as ward visitor ward visitor serves 120serves 120

bedsbeds

1970s 1980s 1990s 2000s

Community Pharmacy Community Pharmacy Patient Patient

Medication RecordsMedication Records

Pharmacy Patient Pharmacy Patient Computer RecordsComputer Records

and Services toand Services to Elderly Nursing Elderly Nursing

HomesHomes

Primary Care Primary Care PharmacyPharmacy

Targeted Services Targeted Services

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VerifyingVerifyingTreatmentTreatment VerifyingVerifyingTreatmentTreatment

Monitoring Monitoring TreatmentTreatmentMonitoring Monitoring TreatmentTreatment

Confirming OutcomesConfirming Outcomesof Treatmentof Treatment

Confirming OutcomesConfirming Outcomesof Treatmentof Treatment

Transferring careTransferring careTransferring careTransferring care

Clinical Management Plan

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Profile of Patient’s CharacteristicsProfile of Patient’s CharacteristicsPatient Comprehension/ParticipationPatient Comprehension/Participation

Confirmation of NeedConfirmation of Need

Drug HistoryDrug HistoryContra-indications/InteractionsContra-indications/Interactions

Treatment PlanTreatment PlanConformity to GuidelinesConformity to Guidelines

Achievement of Achievement of Treatment GoalsTreatment Goals

Confirmation of SafetyConfirmation of Safety

Individualised Dose,Individualised Dose,Dose Frequency, Dose Frequency,

Means of AdministrationMeans of AdministrationAdherence Adherence

to Treatmentto Treatment

Clinical MonitoringClinical MonitoringLaboratory MarkersLaboratory Markers

VerificationVerificationConfirmationConfirmation of of

outcomesoutcomes

MonitorinMonitoringg

Unwanted SymptomsUnwanted Symptoms

Recorded Recorded Adverse ReactionAdverse Reaction

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Patient ProfilePatient Profile

Laboratory tests

Laboratory tests

MedicationMedication

Pharmaceutical care planPharmaceutical care plan

DocumentatioDocumentationn

DocumentatioDocumentationn

ResponsibilitResponsibilityy

ResponsibilitResponsibilityy

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History

• 1940~1960 Era of Expansion period• 1970~1980 Era of Cost containment• 1990~ Era of Assessment and Accountability for Health Outcome

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Definition of Pharmacoeconomics

• The process of identifying, measuring, and comparing the costs, risks, and benefits of programs, services, or therapies

• To determine which alternative produces the best health outcome for the resource invested

• Most impactful when making decisions about a population rather than individual

• “Costs vs. Consequences of Alternatives”

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Micro to Macro Applications with Pharmacoecomomics

Education in safe and effective prescribing practices. AAMC. July 2008.

From Board Room to Bedside

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Perspective of Pharmacoeconomics

• Patient perspective

• Provider perspective

• Payer perspective

• Societal perspective

1. Direct medical costs

2. Direct non medical costs

3. Indirect nonmedical costs

4. Intangible costs

5. Opportunity costs

6. Incremental costs

After selection of perspective next step cost related

measurements

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Application of Pharmacoeconomics

Clinical Pharmacy Service Evaluation• Determining the value of an existing services• Estimating the potential worth of implementing a new service• Capturing the value of a “cognitive” clinical intervention• Industry-marketing pricing, performance guarantee• Managed care – protocols, guidelines, formularies• Physicians – individual patient treatment decisions, prescribing,

payer-performance• Consumer – education, autonomy• Government – pricing, approval, formularies, policy• Institution – protocol, guidelines, formularies• Pharmacist – formularies, protocol, guideline, pharmaceutical care

service or program evaluation

Drug Therapy Evaluation –

Selective the most cost-effective drugs for an organizational formulary

Making a decision about an individual patient’s therapy

Customizing a patient’s pharmacotherapy

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