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PMC1 |
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USING DRUG PRICE
DISCREPANCY INDEX TO IMPROVE EFFICIENT USE OF
PHARMACY BUDGET
Kulsomboon V, Sriwiriyanuparb W,
Chulalongkorn University, Bangkok, Thailand
OBJECTIVE:
Since 1999, the Ministry of Public Health (MOPH), Thailand, has developed
website to inform reference drug price to public
health service institutions. The objectives of
this study were to analyze the available reference
drug price data and compare the price based on
Weighted Average Price (WAP) and Drug Price
Discrepancy Index (DPDI). METHODS:
Drug price data in 2001 were used for the analyses. The 62 drugs from a
provincial collective drug purchasing database
were selected based on the their high expenditure
and the same 62 drugs were also selected from an
individual purchasing database for studying their
purchasing prices. The WAP and DPDI of individual
drugs were calculated. The WAP was calculated from
every unit price and volume purchased divided by
total amount of drug purchased. Drug Price
Discrepancy Index (DPDI) was the ratio of the
individual unit price of each collective
purchasing group and the WAP. To determine high
unit price of purchased drug for individual
collective purchasing group, the acceptable DPDI
was set up to be no greater than 1.2. The WAP and
DPDI of each drug were compared within the
collective or individual purchasing group.
RESULTS:
Of the drug purchased by collective purchasing at provincial level, 15
(24%) drugs had a high purchasing price and of the
drug purchased by individual purchasing, 20 (32%)
drugs had high a purchasing price. The WAP and
DPDI parameter provided the group of target drugs
to be monitored to prevent highly purchased drug
prices.
CONLUSIONS:
The WAP might be used to assist hospital in drug procurement to improve the
efficient use of the pharmacy budget. Other
affiliating factors including quality of drug
should also be considered in actual purchasing. It
is anticipated that the DPDI will enable the
collective purchasing network and MOPH to be aware
of high unit prices of drugs purchased around the
country.
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PMC2 |
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PHARMACOECONOMIC ASPECTS
OF THE ADMINISTRATIVE REFORMS IN PHARMACEUTICAL
SECTORS OF REPUBLIC HEALTH DEPARTMENTS IN
MONTENEGRO
Tomic Z1, Sabo A1, Bralic R2, Glomazic Z2,
Mikov M1, Lazovic V3, 1Faculty of Medicine, Novi
Sad, Serbia and Montenegro, 2Republic Health
Department, Podgorica, -, Serbia and Montenegro,
3Faculty of Economy, Podgorica, Serbia and
Montenegro OBJECTIVE:
In 2002 in Montenegro, there was no efficient system to follow up the
prescribing practice in outpatient clinics. The
total expenses for drugs were so high that they
threatened to diminish the whole system of drug
supply. Therefore in 2003 at the whole Montenegro
republic a system to follow up the drug
prescribing in outpatient practice was
implemented. METHODS:
The system consisted of the central unit in the Republic health system in
the Republic central health service, and the all
pharmacies which give drugs on the prescriptions
were covered financially by the Republic health
centre. System started on January 1,2004; System
contains bases with all drugs on market in
Montenegro, all doctors, pharmacists, drug users
and enables to follow the drugs way from each
doctor to the patient. At the same time the
Republic health centre introduced the new list of
drugs refunded by the Republic health centre. The
list of drugs refunded by the Republic health
centre so called positive list covered all
important drugs, and was prepared in accordance to
new pharmacotherapeutic guidelines. ATC/DDD
classification of drugs was used. RESULTS:
Analysis performed one year after implementation
showed that the use of drugs significantly
decreased(15,68%) when compared with 2002.
Expenses were 1,5 mil E lower than in 2002/2003.
From the all drugs, the most often issued drugs
were for arterial hypertension and for
tonsilopharingitis, more than 25% of all
prescriptions. The structure of drugs prescribed
was improved when compared with the
pre-implementation period. CONLUSIONS:
Permanent monitoring and periodic analyses of informations obtained from an
information system in the future will improve
rationalization of the drug prescribing.
Monitoring and analyses will show if some other
administrative measurements are needed to keep
this positive trend on.
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PMC3 |
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USE OF OBSERVATIONAL
HEALTH DATABASES FOR RESEARCH IN PHARMACOECONOMICS
AND PHARMACOEPIDEMIOLOGY
Guo JJ, University of Cincinnati,
Cincinnati, OH, USA OBJECTIVE:
Observational data often contain retrospective
patient-specific and populationbased information,
and have been widely used for health services and
outcomes research. The objective of this study is
to review and compare characteristics of public
and proprietary health care databases available
for research in Pharmacoeconomics, epidemiology,
and outcomes research. METHODS:
Published information and literature on health
care databases other than clinical trials were
searched using Medline, International
Pharmaceutical Abstracts, Internet, as well as
other commercially available sources. RESULTS:
Over 51 public health data sources or proprietary
health care databases were selected for review.
This paper discussed major characteristics of
these selected healthcare databases by categories,
including: 1) electronic claims databases, like US
Medicare and Medicaid, Canadian Saskatchewan
health database, US Veterans Affairs clinic
databases, regional Blue Cross/Blue Shield
database; 2) medical record databases, like
Harvard Pilgrim health care, United Health Group,
UK General Practice Research Database, Kaiser
Permantente; 3) spontaneous adverse drug reaction
reporting systems, like Food Drug Administration
Adverse Event Reporting Systems, Canadian Adverse
Drug Reaction Monitoring Program, World Health
Organization Adverse Reaction database, and UK
Yellow Card; 4) health care survey data, like US
Medical Expenditure Panel Survey (MEPS), and
National Ambulatory Medical Care Survey; and
5)disease registries and other health data, like
Surveillance Epidemiology and End Results,
Metropolitan Atlanta Congenital Defect Program,
and National Death Index. In addition, the linkage
capability of health data files, data validity,
and health privacy issues were also discussed.
CONLUSIONS:
Many public and proprietary healthcare databases
are available for research in Pharmacoeconomics
and Pharmacoepidemiology. This review article on
healthcare databases provides useful information
to compare and identify potential appropriate
databases for specific research objectives.
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PMC4 |
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SELECTING A PROPER EQ-5D
VALUE SET MODEL FOR TAIWAN POPULATION
Tarn YH1, Chang TJ2, 1Taipei City Hospital,
Taipei, Taiwan, 2Tri-Service General Hospital,
Taipei, Taiwan OBJECTIVE:
The objective of this study is to select a
suitable EQ-5D value set model for Taiwan
population.
METHODS:
Data for valuation of EQ-5D health states were
obtained via three METHODS:
a) through postal survey value analog scale (VAS);
using the standard EQ- 5D format; A random
sampling 12,924 adults was surveyed. b) VAS and c)
Time Trade-Off (TTO) interview methods were used
to interview patients and care givers in a medical
center. There were 228 adults interviewed. Four
methods were used to exclude responses from
individuals to better fit the model. A: According
to EuroQol exclusion criteria. B: when A+(7). C:
when A+(5)+(6). D: C+(7). The study used four
criteria to select the proper EQ-5D model: the
higher adjust R2, smaller actual and estimated
value difference, higher correlation with EuroQol
model, larger sample size, the preference value
(PV) graph had the similar pattern as EuroQol
value set chart. RESULTS:
In VAS method either by postal survey or
interview, the study indicate that D method was
proper and the PV adjusted R2 achieving 0.53~0.57.
In TTO interview method indicate that all A~D
exclusion criteria results in the preference value
adjusted R2 of 0.48. In N2N3/VAS/D and N2N3/TTO/A
models the actual and estimated value difference
was smaller and higher correlation with EuroQol
model than N3/VAS/D and N3/TTO/A. The N2N3/VAS/D
and N2N3/TTO/A model had the similar pattern as
EuroQol value set chart.
CONLUSIONS:
The N2N3/VAS/D/Postal and N2N3/TTO/A models
adjusted R2 achieve 0.53~0.48 and the correlation
with EuroQol model achieve 0.907~0.966. The two
models can be used to interpolate values of the
states for which there is no direct observation.
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PMC5 |
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FEASIBILITY AND
ACCEPTABILITY OF TTO AND SG AND FACTORS
INFLUENCING THEIR ACCEPTANCE FOR HEALTH VALUATION
AMONG SINGAPOREANS
Wee HL1, Li SC2, Xie F2, Zhang XH2, Luo
N3, Cheung YB4, Machin D5, Fong KY1, Thumboo J1,
1Singapore General Hospital, Singapore, 2National
University of Singapore, Singapore, 3QualityMetric
Inc, Lincoln, RI, USA, 4London School of Hygiene &
Tropical Medicine, London, United Kingdom,
5National Cancer Centre, Singapore
OBJECTIVE:
As time trade-off (TTO) and standard gamble (SG)
are well-established health valuation techniques
(with advantages and disadvantages), their
feasibility and acceptability are important in
selecting either technique for population-based
health valuation studies. We therefore evaluated
the feasibility, acceptability and factors
influencing acceptance of TTO and SG among Chinese
and Indian Singaporeans. METHODS:
In in-depth interviews with adult Chinese and
Indian Singaporeans (selected to represent various
ages/ educational levels) conducted in English,
Chinese or Tamil, respondents sorted and ranked 3
hypothetical health states using a 0-100 visual
analogue scale (VAS), then generated utilities for
these health states using both TTO and SG (order
randomized). Respondents and interviewers
evaluated (using 0-10 VAS) various aspects of
these exercises. We explored associations between
ethnic and sociodemographic variables and health
preferences using Mann-Whitney, chi-squared tests
or logistic regression analysis. RESULTS:
Among 45 respondents (53% Chinese, 53% female,
median age: 41 years), reported preference for TTO
(n=23) or SG (n=21) was similar. Clarity and
comprehension of instructions, ease of completion
and amount of concentration needed were similar
for both TTO and SG, with the exception of Chinese
respondents’ giving lower ratings for clarity of
SG instructions compared to Indians (median (IQR):
8.5 (7.0, 9.0) versus 10.0 (8.5, 10.0), p=0.011).
Interviewers judged that respondents had little
difficulty completing, were able to understand,
and required the same amount of concentration for
TTO and SG, and reported that respondents easily
understood and completed sorting and ranking
exercises. In exploratory subgroup analysis using
logistic regression, only less education was
associated with preference for TTO over SG (odds
ratio 5.8 (95% CI 1.05 to 32.2, p=0.044).
CONLUSIONS:
Feasibility and acceptability of TTO and SG among
Chinese and Indian Singaporeans are high. Although
there was no preference for TTO or SG in general,
TTO was preferred by subjects with less education.
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PMC6 |
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A SURVEY OF PATIENT
REPORTED OUTCOME(PRO) CLAIMS IN PHARMACEUTICAL
ADVERTISING
Yuwaree V, Rojsutee S, Thavorncharoensap M,
Mahidol University, Bangkok, Thailand
OBJECTIVE:
To investigate the quantity and quality of
Patient-Reported Outcome (PRO) claims in
pharmaceutical advertisements in two Thai medical
journals. METHODS:
A retrospective review of all pharmaceutical
advertisements in the 2004 issues of 2 Thai
medical journals(Clinic and Pharmatime) was
performed by 3 trained pharmacists.Two reviewers
independently reviewed the advertisements. If the
reviewers disagreed the final decision was made by
the third reviewer. All distinctive pharmaceutical
advertisements were classified into claim
advertisement or reminder advertisement. PRO
claims and economic claims were also identified.
Then, the advertisements were categorized
according to their reference statuses. Finally,
the reviewers evaluated whether the cited
references provided substantial evidence to
support the claims. RESULTS:
From 183 advertisements reviewed, there were 48
distinctive advertisements. Forty-five (0.94%) and
three (0.06%) of the advertisements were
classified as claim advertisement and reminder
advertisement, respectively. Nineteen (0.42%) of
the claim advertisements contained PRO claims
while two(0.04%) of the claim advertisements
contained economic claims. The result indicated
that only 16 (0.36 %) of the claim advertisements
cited at least one published article retrievable
from Medline as a reference, while the remaining
24 (0.49%) contained no reference or cited package
insert or non-published data on file as
references. When looking closely at PRO claims, it
was found that 12 (0.63%) of the PRO claims were
misleading because the outcomes stated in the
claims were not supported by the given references.
In addition, there was not sufficient evidence to
support all 2 economic claims. CONLUSIONS:
More than half of the PRO claims were misleading.
Practitioners should be cautions in assessment of
PRO claim advertisements in medical journals.
There is also a substantial need for more rigorous
regulation of PRO claims.
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PMC8 |
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AFFORDABLE BOOTSTRAPS?
EVALUATING FREEWARE OPTIONS FOR ANALYZING
INCREMENTAL COST EFFECTIVENESS DATA
McGhan W, Gandhi P, Ruparel P, Peterson A,
University of the Sciences, Philadelphia, PA, USA
OBJECTIVE:
To compare and evaluate freeware options for
bootstrap analyses for incremental cost
effectiveness data. METHODS:
Obenchain’s ICEplane software can be downloaded
and installed from
www.math.iupui.edu/~indyasa/bobodown.htm. This
software was compared against the web-based
analyses available through HDS at
www.healthstrategy. com. Three datasets, from the
Obenchain site, were used in the comparisons. The
datasets are from published studies dealing with
abciximab (ABX), tricyclic antidepressants (TCA),
and pindolol (PIN). RESULTS:
ICEplane must be installed on MS Windows operating
systems and the HDS program runs online through
any operating system with browsers such as
Internet Explorer, Netscape or Firefox. Both
software options provide output graphs such as
scatter plots, confidence intervals and
acceptability curves. ICEplane and HDS calculators
both generated statistics on the initial raw data
such as mean, median, standard deviation and
standard error. Bootstrapped statistics include
incremental cost- effectiveness ratio (ICER), and
95% Confidence Intervals. Respective mean ICERs
and confidence intervals between ICEplane and HDS
bootstraps are as follows: ABX: 3771 (-665, 20797)
vs 3692 (-1054, 13303); PIN: -1880 (2665, -421) vs
-1259 (16939,-260) and TCA: -16.48 (-169, 136) vs
-19.96 (-221, 147). CONLUSIONS:
The Obenchain software has additional statistical
and charting features that are not available in
the HDS program. The analyses from the HDS site
runs slowly on more than 1000 bootstrap
replications, but the results obtained compare
well to ICEplane. The analyses from the Obenchain
site can perform up to 25,000 replications.
ICEplane and HDS calculate Fieller’s statistic on
both raw and boostrapped data. ICEplane allows
calculations with missing data, while HDS requires
manual recoding. Both of these programs should
make it easier for individuals to perform basic
bootstrap analysis of their data, but certainly
more powerful and user-friendly statistical
software packages would be preferred.
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