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

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