(01) Pharmacoeconomics
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Transcript of (01) Pharmacoeconomics
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NeedNeed WantWant UNLIMITEDUNLIMITED
Buying PowerBuying Power
DemandDemandPRICEPRICE
SupplySupply OperationOperation
ResourceResource ProductionProduction
RARERARE
HEALTH ECONOMICS
HEALTH ECONOMICS
PHARMACOECONOMICS
Pharmaceuticals are the mostPharmaceuticals are the most
• cost-effective, cost-effective,
• value-added, value-added,
• least-invasive least-invasive part of the health-care part of the health-care
system.system.
Alan Holmer, President of the Alan Holmer, President of the Pharmaceutical Pharmaceutical
Research and Manufacturers of America Research and Manufacturers of America
(PhRMA), 1998(PhRMA), 1998
Pharmacoeconomics is a Pharmacoeconomics is a
branch of health economics branch of health economics
primarily concerned with primarily concerned with
assessing assessing
the cost-effectiveness the cost-effectiveness
of drug therapies.of drug therapies.
Growing importance of Growing importance of
PHARMACOECONOMICSPHARMACOECONOMICS•Pressure on healthcare Pressure on healthcare
budgetbudget
• Interest in economic Interest in economic data from government, data from government, insurers, formulary insurers, formulary committeescommittees
•Formal requirement Formal requirement for economic data in for economic data in some jurisdictions some jurisdictions (eg. Australia, (eg. Australia, Canada etc.)Canada etc.)
MAJOR TRENDS IN THE MAJOR TRENDS IN THE PHARMACEUTICAL PHARMACEUTICAL INDUSTRYINDUSTRY• Rising expenditures on drugs Rising expenditures on drugs
(though drugs still a relatively (though drugs still a relatively small % of overall health small % of overall health spending)spending)
• Aging populationAging population• High and rising costs of drug High and rising costs of drug
developmentdevelopment• Innovative products (though Innovative products (though
slowing?)slowing?)• Competition -- from generics Competition -- from generics
and other brand-namesand other brand-names• Pressures from payers Pressures from payers
(managed care, government)(managed care, government)• Drug industry responseDrug industry response• Rising spending on R&DRising spending on R&D• Rising spending on marketing: Rising spending on marketing:
OTC, etc.OTC, etc.• Drugs promoted as a cost-Drugs promoted as a cost-
effective strategyeffective strategy
Year
1960 $141
1970 $341
1980 $1,052
1990 $2,689
1998 $4,094
US Healthcare Spending Per Person
Country
USA $2,689Switzerland $2,412Germany $2,222Luxemburg $2,206Canada $2,002Indonesia < $ 10 (?)
Healthcare Spending Per
Person Per Year
DRUG EXPENDITURE PER CAPITA (USD)DRUG EXPENDITURE PER CAPITA (USD)
COUNTRYCOUNTRYPER CAPITA PER PER CAPITA PER YEAR YEAR
USAUSA $756.20$756.20 40%40%
JAPANJAPAN $463.30$463.30
GERMANYGERMANY $319.70$319.70
TAIWANTAIWAN $119.50$119.50
KOREAKOREA $104.50$104.50
SINGAPORESINGAPORE $58.50$58.50
HONG KONGHONG KONG $53.40$53.40
THAILAND THAILAND $16.20$16.20
MALAYSIAMALAYSIA $15.80$15.80
PHILIPPINESPHILIPPINES $14.10$14.10
INDONESIAINDONESIA $7.70$7.70 15%15%
CHINACHINA $5.80$5.80
VIETNAMVIETNAM $5.40$5.40
What will be What will be covered?covered?
• Rx drug industry and Rx drug industry and the FDAthe FDA
• Regulation of drugs and Regulation of drugs and promotional claimspromotional claims
• Reimbursement and Reimbursement and pricing issuespricing issues
• Case studies in Case studies in pharmacoeconomicspharmacoeconomics
• Alzheimer’s diseaseAlzheimer’s disease
• Thrombolytic therapyThrombolytic therapy
• ““Lifestyle” drugsLifestyle” drugs
• OthersOthers
• ““The real world”The real world”
Why Pharmacoeconomics ?
• Pharmacoeconomic information is being widely disseminated;
• The information can help payers, managers, consumers, physicians, regulators, analysts make better decisions;
• There is (legitimate) concern about the quality of analyses;
• There is great demand for skilled practitioners.
• Decision theoryDecision theory
• Decision analysis for health and Decision analysis for health and medical practicemedical practice
• Decision analysis in clinical researchDecision analysis in clinical research
• Methods for decision analysis in health Methods for decision analysis in health care technology assessmentcare technology assessment
• Cost-effectiveness and cost-benefit Cost-effectiveness and cost-benefit analysis for health program evaluationanalysis for health program evaluation
• EconomicsEconomics
OCCUPATIONAL RANKING IN TERM OCCUPATIONAL RANKING IN TERM OF HONESTY AND ETHICAL OF HONESTY AND ETHICAL
STANDARDSTANDARDGALLUP POLL 1985GALLUP POLL 1985GALLUP POLL 1993GALLUP POLL 1993
OCCUPATION OCCUPATION PROFESSIONPROFESSION
1985 1985 SCORSCOR
EE
1985 1985 RANRAN
KK
1993 1993 SCORESCORE
1993 1993 RANRAN
KKCLERGYMANCLERGYMAN 67 1 5353 22
PHARMACISTPHARMACIST 65 2 6565 11
MEDICAL MEDICAL DOCTORDOCTOR
58 3 5151 44
DENTISTDENTIST 56 4 5050 66
COLLEGE COLLEGE TEACHERTEACHER
54 5 5252 33
ENGINEERENGINEER 53 6 4949 77
POLICEMANPOLICEMAN 47 7 5050 55
BANKERBANKER 37 8 2828 1010
TV REPORTER / TV REPORTER / COMMENTATORCOMMENTATOR
33 9 2828 99
JOURNALISTJOURNALIST 31 10 2626 1111
NEWSPAPER NEWSPAPER REPORTERREPORTER
29 11 2222 1212
LAWYERLAWYER 27 12 1616 1717
BUSINESS BUSINESS EXECUTIVEEXECUTIVE
23 13 2020 1313
FUNERAL FUNERAL DIRECTORDIRECTOR
-- - 3434 88
BUILDING BUILDING CONTRACTORCONTRACTOR
-- - 2020 1414
1985 1985 SCORESCORE
1985 1985 RANKRANK
1993 1993 SCORESCORE
1993 1993 RANKRANK
LOCAL OFFICE LOCAL OFFICE HOLDERSHOLDERS
- - 1919 1515
US SENATORSUS SENATORS - - 1818 1616
TV TALK SHOW TV TALK SHOW HOSTSHOSTS
- - 1616 1818
REAL ESTATE REAL ESTATE AGENTSAGENTS
- - 1515 1919
LABOR UNION LABOR UNION LEADERSLEADERS
- - 1414 2020
CONGRESSMECONGRESSMENN
- - 1414 2121
STATE OFFICE STATE OFFICE HOLDERSHOLDERS
- - 1414 2222
STOCKBROKERSTOCKBROKERSS
- - 1313 2323
INSURANCE INSURANCE SALESMENSALESMEN
- - 1010 2424
ADVERTISING ADVERTISING PRACTITIONERPRACTITIONER
SS
- - 88 2525
CAR CAR SALESMENSALESMEN
- - 66 2626
OCCUPATIONAL RANKING IN TERM OF OCCUPATIONAL RANKING IN TERM OF HONESTY AND ETHICAL STANDARDHONESTY AND ETHICAL STANDARD
GALLUP POLL 1985GALLUP POLL 1985GALLUP POLL 1993GALLUP POLL 1993
Generic Sales Generic Sales DevelopmentDevelopment2000 – 20042000 – 2004
0
200
400
600
800
1000
1200
1400
1600
1800
2000
2200
2400
1999 2000 2001 2002 2003 2004
NPanel
IHPA
IDA
IPA
Generic Sales Development Generic Sales Development by sectorby sector
2000 – 20042000 – 2004
2000 2001 2002 2003 2004 Total Market 1,140 1,574 1,732 1,860 2,187
Panel Market 439 537 577 640 756
IPA 176 226 247 273 335
IDA 128 154 149 162 182
IHPA 135 157 181 205 239
Non-Panel Mkt 701 1,037 1,155 1,220 1,431
Total Pharma MarketTotal Pharma Market2004/20032004/2003
0
5,000
10,000
15,000
20,000
25,000
IPA IDA IHPA NP Eth NPOTC
TOTAL
Market Sector
Rp b
n 20032004
Total Pharma MarketTotal Pharma Market2004/20032004/2003
Value Rp bn 2004 2003 + % TOTAL MARKET ( ITMA ) 20,873 17,458 19.6 PANEL MARKET 9,509 8,650 9.9 IPA 4,662 4,233 10.1 IDA 2,517 2,379 5.8 IHPA 2,330 2,038 14.3
NON-PANEL MARKET 11,363 8,808 29.0 Ethical (clinic, doctor etc) 5,693 4,541 25.4 OTC (S.Market, Warung etc) 5,670 4,267 32.9
Generic Market Share by Generic Market Share by sectorsector
2000 – 2004 (%)2000 – 2004 (%) 2000 2001 2002 2003 2004
Total Market
11.5 12.4 11.1 10.7 10.5 Panel Market
7.3 7.9 7.6 7.4 7.9 IPA 5.9 6.8 6.5 6.4 7.2 IDA 7.0 7.8 7.5 6.8 7.2 IHPA 11.4 10.5 10.3 10.0 10.3 Non-Panel Market
17.6 17.7 14.3 13.9 12.6
OCCUPATIONAL RANKING OCCUPATIONAL RANKING IN TERM OF HONESTY AND ETHICAL IN TERM OF HONESTY AND ETHICAL
STANDARDSTANDARDUS GALLUP POLL 1985 / 1993US GALLUP POLL 1985 / 1993
Occupation / Occupation / 1985 1985 1985 1985 1993 1993 1993 1993 Profession Profession SCORE RANK SCORE RANK SCORE RANK SCORE RANKREAL ESTATE AGENTSREAL ESTATE AGENTS - - -- 15 19 15 19
LABOR UNION LEADERSLABOR UNION LEADERS - - -- 14 20 14 20
CONGRESSMENCONGRESSMEN - - - - 14 21 14 21
STATE OFFICE HOLDERSSTATE OFFICE HOLDERS - - -- 14 22 14 22
STOCKBROKERSSTOCKBROKERS - - - - 13 23 13 23
INSURANCE SALESMENINSURANCE SALESMEN - - -- 10 24 10 24
ADVERTISING ADVERTISING
PRACTITIONERS -PRACTITIONERS - -- 8 25 8 25
CAR SALESMEN -CAR SALESMEN - -- 6 26 6 26
Generic Market Share by Generic Market Share by sectorsector
2000 – 2004 (%)2000 – 2004 (%)
2000 2001 2002 2003 2004
Total Market
11.5 12.4 11.1 10.7 10.5 Panel Market
7.3 7.9 7.6 7.4 7.9 IPA 5.9 6.8 6.5 6.4 7.2 IDA 7.0 7.8 7.5 6.8 7.2 IHPA 11.4 10.5 10.3 10.0 10.3 Non-Panel Market
17.6 17.7 14.3 13.9 12.6
Year
1960 $141
1970 $341
1980 $1,052
1990 $2,689
1998 $4,094
US Healthcare Spending Per Person
DRUG EXPENDITURE DRUG EXPENDITURE ( USD ) ( USD ) 2003 - 20042003 - 2004 CCOUNTRYOUNTRY PER CAPITA PER YEARPER CAPITA PER YEAR
USAUSA $ $ 756.20 756.20 40%40% JAPAN JAPAN $ $ 463.30 463.30 GENERIKGENERIK
GERMANY GERMANY $ $ 319.70 319.70 TAIWAN TAIWAN $$ 119.50 119.50 KOREA KOREA $ $ 104.50 104.50 SINGAPORESINGAPORE $$ 58.50 58.50 HONG KONGHONG KONG $$ 53.40 53.40 THAILAND THAILAND $ $ 16.20 16.20 MALAYSIA MALAYSIA $ $ 15.80 15.80 PHILIPPINES PHILIPPINES $$ 14.10 14.10 INDONESIAINDONESIA $$ 7.70 7.70 15%15% CHINA CHINA $$ 5.80 5.80 GENERIKGENERIK
VIETNAMVIETNAM $ $ 5.40 5.40
NeedNeed Want Want UnlimitedUnlimited
Buying Buying PowerPower
DemandDemand
PRICEPRICE SupplySupply
OperationOperation RareRare
ResourceResource
ProductionProduction
Country
USA $2,689Switzerland $2,412Germany $2,222Luxemburg $2,206Canada $2,002Indonesia < $ 10 (?)
Healthcare Spending Per
Person Per Year
OCCUPATIONAL RANKINGOCCUPATIONAL RANKING IN TERM OF HONESTY AND ETHICAL IN TERM OF HONESTY AND ETHICAL
STANDARD STANDARDUS GALLUP POLL 1985 / 1993US GALLUP POLL 1985 / 1993
Occupation / Occupation / 1985 1985 1985 1985 1993 1993 1993 1993 Profession SCORE Profession SCORE RANK SCORE RANK RANK SCORE RANKCLERGYMANCLERGYMAN 67 67 1 1 5353 2 2
PHARMACISTPHARMACIST 65 65 2 2 6565 1 1
MEDICAL DOCTORMEDICAL DOCTOR 5858 3 3 5151 4 4
DENTISTDENTIST 56 56 4 4 5050 6 6
COLLEGE TEACHER 54COLLEGE TEACHER 54 5 5 52 52 3 3
ENGINEERENGINEER 53 53 6 6 4949 7 7
POLICEMAN 47POLICEMAN 47 7 7 50 50 5 5
BANKERBANKER 37 37 8 8 2828 10 10
TV REPORTER / TV REPORTER /
COMMENTATORCOMMENTATOR 33 33 9 9 2828 9 9
Total Pharma MarketTotal Pharma Market2004/20032004/2003
Value Rp bn 2004 2003 + % TOTAL MARKET ( ITMA ) 20,873 17,458 19.6 PANEL MARKET 9,509 8,650 9.9 IPA 4,662 4,233 10.1 IDA 2,517 2,379 5.8 IHPA 2,330 2,038 14.3
NON-PANEL MARKET 11,363 8,808 29.0 Ethical (clinic, doctor etc) 5,693 4,541 25.4 OTC (S.Market, Warung etc) 5,670 4,267 32.9
Total Pharma MarketTotal Pharma Market2004/20032004/2003
0
5,000
10,000
15,000
20,000
25,000
IPA IDA IHPA NP Eth NPOTC
TOTAL
Market Sector
Rp bn
20032004
Generic Sales Development Generic Sales Development by sectorby sector
2000 – 20042000 – 2004
2000 2001 2002 2003 2004 Total Market 1,140 1,574 1,732 1,860 2,187
Panel Market 439 537 577 640 756
IPA 176 226 247 273 335
IDA 128 154 149 162 182
IHPA 135 157 181 205 239
Non-Panel Mkt 701 1,037 1,155 1,220 1,431
Generic Sales Generic Sales DevelopmentDevelopment
2000 – 20042000 – 2004
0
200
400
600
800
1000
1200
1400
1600
1800
2000
2200
2400
1999 2000 2001 2002 2003 2004
NPanel
IHPA
IDA
IPA
NeedNeed Want Want UnlimitedUnlimited
Buying Buying PowerPower
DemandDemand
PRICEPRICE SupplySupply
OperationOperation RareRare
ResourceResource
ProductionProduction
Country
USA $2,689Switzerland $2,412Germany $2,222Luxemburg $2,206Canada $2,002Indonesia < $ 10 (?)
Healthcare Spending Per
Person Per Year
Year
1960 $141
1970 $341
1980 $1,052
1990 $2,689
1998 $4,094
US Healthcare Spending Per Person
DRUG DRUG EXPENDITURE EXPENDITURE ( USD ) ( USD ) 2003 - 2003 - 20042004 CCOUNTRYOUNTRY PER CAPITA PER YEARPER CAPITA PER YEAR USAUSA $ $ 756.20 756.20 40%40% JAPAN JAPAN $ $ 463.30 463.30
GENERIKGENERIK
GERMANY GERMANY $ $ 319.70 319.70
TAIWAN TAIWAN $$ 119.50 119.50
KOREA KOREA $ $ 104.50 104.50
SINGAPORESINGAPORE $$ 58.50 58.50
HONG KONGHONG KONG $$ 53.40 53.40
THAILAND THAILAND $ $ 16.20 16.20
MALAYSIA MALAYSIA $ $ 15.80 15.80
PHILIPPINES PHILIPPINES $$ 14.10 14.10
INDONESIAINDONESIA $$ 7.70 7.70 15%15% CHINA CHINA $$ 5.80 5.80 GENERIKGENERIK
VIETNAMVIETNAM $ $ 5.40 5.40
Generic Market Share by Generic Market Share by sectorsector
2000 – 2004 (%)2000 – 2004 (%)
2000 2001 2002 2003 2004
Total Market
11.5 12.4 11.1 10.7 10.5 Panel Market
7.3 7.9 7.6 7.4 7.9 IPA 5.9 6.8 6.5 6.4 7.2 IDA 7.0 7.8 7.5 6.8 7.2 IHPA 11.4 10.5 10.3 10.0 10.3 Non-Panel Market
17.6 17.7 14.3 13.9 12.6
OCCUPATIONAL RANKINGOCCUPATIONAL RANKING IN TERM OF HONESTY AND ETHICAL IN TERM OF HONESTY AND ETHICAL
STANDARD STANDARDUS GALLUP POLL 1985 / 1993US GALLUP POLL 1985 / 1993
Occupation / Occupation / 1985 1985 1985 1993 1993 1985 1993 1993 Profession Profession SCORE RANK SCORE SCORE RANK SCORE RANK RANKCLERGYMANCLERGYMAN 67 67 1 1 53 53 2 2
PHARMACISTPHARMACIST 65 65 2 2 65 65 1 1
MEDICAL DOCTORMEDICAL DOCTOR 5858 3 3 51 51 4 4
DENTISTDENTIST 56 56 4 4 50 50 6 6
COLLEGE TEACHER 54COLLEGE TEACHER 54 5 5 52 52 3 3
ENGINEERENGINEER 53 53 6 6 49 49 7 7
POLICEMAN 47POLICEMAN 47 7 7 50 50 5 5
BANKERBANKER 37 37 8 8 28 28 10 10
TV REPORTER / TV REPORTER /
COMMENTATORCOMMENTATOR 33 33 9 9 28 28 9 9
OCCUPATIONAL OCCUPATIONAL RANKING RANKING
IN TERM OF HONESTY AND IN TERM OF HONESTY AND ETHICAL STANDARDETHICAL STANDARD
US GALLUP POLL 1985 / 1993US GALLUP POLL 1985 / 1993
Occupation / Occupation / 1985 1985 1985 1993 1993 1985 1993 1993 Profession Profession SCORE RANK SCORE RANK SCORE RANKSCORE RANKJOURNALISTJOURNALIST 31 31 10 10 26 11 26 11
NEWSPAPER REPORTERNEWSPAPER REPORTER 29 29 11 11 22 12 22 12
LAWYERLAWYER 27 27 12 12 16 17 16 17
BUSINESS EXECUTIVEBUSINESS EXECUTIVE 23 23 13 13 20 13 20 13
FUNERAL DIRECTORFUNERAL DIRECTOR - - - - 34 8 34 8
BUILDING CONTRACTOR -BUILDING CONTRACTOR - -- 20 14 20 14
LOCAL OFFICE HOLDERS -LOCAL OFFICE HOLDERS - - - 19 15 19 15
US SENATORS -US SENATORS - - - 18 16 18 16
TV TALK SHOW HOSTSTV TALK SHOW HOSTS - - - - 16 18 16 18
OCCUPATIONAL OCCUPATIONAL RANKING RANKING
IN TERM OF HONESTY AND IN TERM OF HONESTY AND ETHICAL STANDARDETHICAL STANDARD
US GALLUP POLL 1985 / 1993US GALLUP POLL 1985 / 1993
Occupation / Occupation / 1985 1985 1985 1993 1993 1985 1993 1993 Profession SCORE Profession SCORE RANK SCORE RANK RANK SCORE RANKREAL ESTATE AGENTSREAL ESTATE AGENTS - - - - 15 19 15 19
LABOR UNION LEADERSLABOR UNION LEADERS - - - - 14 20 14 20
CONGRESSMENCONGRESSMEN - - - - 14 14
21 21
STATE OFFICE HOLDERSSTATE OFFICE HOLDERS - - - - 14 22 14 22
STOCKBROKERSSTOCKBROKERS - - - - 13 23 13 23
INSURANCE SALESMENINSURANCE SALESMEN - - - - 10 24 10 24
ADVERTISING ADVERTISING
PRACTITIONERS -PRACTITIONERS - - - 8 25 8 25
CAR SALESMEN -CAR SALESMEN - - - 6 26 6 26
20002000 20012001 20022002 20032003 20042004
11.511.5 12.412.4 11.111.1 10.710.7 10.510.5
OCCUPATIONAL OCCUPATIONAL RANKING RANKING
IN TERM OF HONESTY AND IN TERM OF HONESTY AND ETHICAL STANDARDETHICAL STANDARD
US GALLUP POLL 1985 / 1993US GALLUP POLL 1985 / 1993
Occupation / Occupation / 1985 1985 1985 1985 1993 1993 1993 1993 Profession Profession SCORE RANK SCORE RANKSCORE RANK SCORE RANKJOURNALISTJOURNALIST 31 31 10 10
26 11 26 11
NEWSPAPER REPORTERNEWSPAPER REPORTER 29 29 11 11 22 12 22 12
LAWYERLAWYER 27 27 12 12 16 17 16 17
BUSINESS EXECUTIVEBUSINESS EXECUTIVE 23 23 13 13 20 13 20 13
FUNERAL DIRECTORFUNERAL DIRECTOR - - - - 34 8 34 8
BUILDING CONTRACTOR -BUILDING CONTRACTOR - - - 20 14 20 14
LOCAL OFFICE HOLDERS -LOCAL OFFICE HOLDERS - - - 19 15 19 15
US SENATORS -US SENATORS - - - 18 16 18 16
TV TALK SHOW HOSTSTV TALK SHOW HOSTS - - - - 16 18 16 18