Post on 13-Jan-2016
Pharmacoeconomics and Outcomes Research
Dean G. Smith, Ph.D.
October 10, 2005
UM Student Chapter
Senior Associate Dean for Administration
Professor of Health Management & Policy
Disclosure
Prescription Drug “Inflation”
-6%
-4%
-2%
0%
2%
4%
6%
8%
10%
12%
14%
1947 1954 1961 1968 1975 1982 1989 1996 2003
Co-Director, Michigan-Pfizer Pharmacoeconomics & Outcomes Research Fellowship Program
http://www.sph.umich.edu/hmp/admissions/pdfellowship.html
Disclosure
The mission of ISPOR is to translate pharmacoeconomics and outcomes research into practice to ensure that society allocates scarce health care resources wisely, fairly, and efficiently.
Further reading …
Designed specifically to meet the clinical informational needs of managed care's Pharmacy and Therapeutics Committee Members.
Editors: Michael E. Chernew, Ph.D.
A. Mark Fendrick, MD
Distribution of Hypercholesterolemia - US
<2F
CHD
2+RF
28%28%
Am J Cardiol 1998;82:61-5.
52%52%31%31%
17%17%
Lovastatin (generic) $0.62Lovastatin (Mevacor) $1.28 Fluvastatin (Lescol 20) $1.67Atorvastatin (Lipitor) $2.18 $2.03Simvastatin (Zocor) $2.29 $2.13Rosuvastatin (Crestor) $2.42 $2.31Pravastatin (Pravacol) $2.67 $2.57
Online prices in the US: 10 mg, 90 tablets drugstore.com June 1, 2005, Medi-Span March 31, 2005
Drug Prices
Drug Prices
Some prices may change Zocor - 2006 Pravacol - 2006 Lipitor - 2011 Crestor - 2016
Current analyses might think about future prices
Hamilton DP, Winslow R. Do statins help prevent cancer? Few tests slated. Wall Street Journal May 20, 2005, B1. B3.
Member, Pharmacy Benefit Oversight Committee
Formulary: http://www.umich.edu/~benefits/plans/ drugs/formulary.htm
Disclosure
Tier 1 $7 Lovastatin (generic)
Tier 2 $14 Atorvastatin (Lipitor) Pravastatin (Pravacol) Rosuvastatin (Crestor) Ezetimibe/Simvastatin
(Vytorin) Niacin/Lovastatin (Advicor)
Tier 3 $24 Lovastatin (Mevacor/Altoprev) Fluvastatin (Lescol/Lescol XL) Simvastatin (Zocor)
U Michigan Formulary
“The mean statin copayment had a large effect on compliance. If the copayment increases by $15, the probability of compliance decreases by 10 percentage points.”
Doesn’t account for the process that might occur with selection of a Tier 2 or Tier 3 agent.
Pharmaceutical Economics
Schultz, O’Donnell et al. Determinants of compliance with statin therapy and LDL-C goal attainment in a managed care setting.American Journal of Managed Care, May 2005.
Member, Board of Directors
MichiganNew Health Plan
Formulary: http://www.molinahealthcare.com/ michigan/provider/formulary.html
Disclosure
StandardLovastatin (generic)Lovastatin (Altoprev)Atorvastatin (Lipitor 10 mg, 20
mg)Ezetimibe/Simvastatin (Vytorin)
Prior AuthorizationAtorvastatin (Lipitor 40 mg, 80
mg)
Molina Michigan Formulary
HOWEVER, price is not value Claiming value requires a
comparison of costs and benefits Some purchasers care about value,
others only price per pill If you care about value, then there's
the short-run LDL-C change or guidelines/goals and the long-run mortality/QALY
Drug Therapy
Week
% Responders
12 24 36 48 540
10
20
30
40
50
60
70
80
90Atorvastatin
Fluvastatin
Pravastatin
Simvastatin
Cumulative Responders
0
500
1000
1500
2000
2500
AtorvastatinFluvastatinPravastatinSimvastatin
*
Total Cost to LDL-C Target
* p < 0.01 vs. others
Smith, McBurney. An Economic Analysis of The Atorvastatin Comparative Cholesterol Efficacy and Safety Study (ACCESS). Pharmacoeconomics, 2003.
Willingness-to-Pay (NCEP)
Miller, Smith, Jones. Cost Effectiveness of Rosuvastatin in Treating Patients to Low-Density Lipoprotein Cholesterol Goals Compared With Atorvastatin, Pravastatin, and Simvastatin (a US Analysis of the STELLAR Trial). American Journal of Cardiology, 2005.
00.10.20.30.40.50.60.70.80.9
1
0 2000 4000 6000 8000 10000
R-10A-10A-40A-80
Questions
?