 President’s
Fireside Chat
Lieven Annemans,
MSc, PhD, HEDM and IMS Health, Meise, Belgium
2004-2005 ISPOR
President
In this month’s Fireside Chat, I
would like to discuss the activities of the Health Science
Policy Council.
This council of high-level members within ISPOR includes all the
ISPOR past-presidents and several key academicians. Their task
is to produce ideas for improving the quality of what ISPOR does
and stands for. They raise issues requiring our attention and
action as an organization both currently and in the future.
I previously mentioned some of
these topics to you in an earlier Fireside Chat (ISPOR
CONNECTIONS Volume 10, Issue 5). Now, I would like to elaborate
on two other issues, one related to drug costs, the other
related to transferability of results of health economic
evaluations.
How to deal with drug
costs: In many evaluations this is not
as simple as we tend to believe. Drug costs, both the costs of
the study drug and the comparators, are often very important
parameters in pharmacoeconomic studies, and in sensitivity
analysis they strongly influence the final result. Yet, compared
with other parameters such as clinical data and utility
estimates, there has been relatively little study of how drug
costs are estimated. Are the methods consistent across studies?
Are the methods theoretically correct? The ISPOR Health Science
Policy Council states correctly that we have to recognize that
the costs of drug regimen do not only involve the estimation of
the drug price, but also the impact of elements such as
discounts, pharmacy, additional costs, and assumptions about
wastage (discarding unused product). Is this wastage to be taken
into account? Can “waste” sometimes be re-used? Different
authors handle this differently. ISPOR should take the lead in
working towards defining the best practices of cost estimates.
Transferability of
economic evaluations: The ISPOR Health
Science Policy Council identified several factors that affect
the transferability of results of econommic evaluations from one
country/setting to another, such as differences in relative
prices, in practice patterns, availability of health care
resources and values of health states. Existing guidelines for
economic evaluation often conflict with each other. It is not
clear which guideline for economic evaluation should be
followed. If guidelines are too flexible (e.g. allowing results
of economic evaluations in country A to be the only source for
decision making in country B) then decisions could be based on
misleading estimates of cost effectiveness. On the other hand,
if the guidelines are too restrictive this could lead to
unnecessary duplication of research. ISPOR should play a role in
identifying which elements of economic data vary most from
setting to setting, and, given the known variability, what would
be reasonable guidelines for accepting (or not accepting) data
from outside the country of interest?
These examples again show we have
an important international role to play regarding issues as
these. After all, that is ISPOR’s mission, and that is where
ISPOR has to put its efforts. And ISPOR has the right people to
do it. |
