Robert Epstein, MD, MS
1998-1999 ISPOR President
Our field of pharmacoeconomics and outcomes research has never been more important than today. Two specific issues are fueling this new decision-makers having a different perspective on drug selection and usage and the unabated societal increases in drug spending year over year. The decision-maker issue involves the increasing role of government, employers, insurers and consumers themselves in the decision-making process. In years past, physicians had complete autonomy to make choices based on safety and efficacy alone. The landscape has changed and today involves other stakeholders (in addition to physicians) who are now attempting to weigh cost against quality. The backdrop for this is the relentless double-digit increase of drug budgets for most populations, leaving many decision-makers wondering about the value of this expenditure. Figure 1 demonstrates in the US that the majority of this expenditure is not due to inflation, but utilization and drug mix again questioning the inherent value of that incremental spending.
To address the issue of cost, drug budget managers have moved from unit cost reduction (e.g. retail networks, reference pricing, manufacturer contracting or cost sharing) in the 1970s, to utilization management (e.g. formularies, DUR, prior authorization) in the 1980s, to outcomes management (e.g. guidelines, disease management, pharmacoeconomics) in the 1990's. All of these schemes involve a recognition that there is a finite limit on drug spending, although clinicians and consumers have not altogether embraced that issue. The fact that our field attempts to combine issues related to cost and quality has not gone unnoticed.
Why our field has not been even more successful in this arena is the story of several shortfalls. There is a relative dearth of practical applications, interpretability of results is often lacking, training is fragmented, silo mentality persists among decision-makers, policy decisions are frequently made in the absence of economic considerations, and there has traditionally been no 'home' for those interested in the field. For all of these reasons (and more), our Society, a non-profit organization, was formed. For those of us intrigued with translating science into practice this is the place.
During the past year, I was honored to serve you and to push forward on three themes that I felt were imperative to our growth; shoring up our infrastructure at the Society, playing a bigger role in health policy, and going global. Assisted by a wonderful and active Board of Directors, a series of committed Committees and Chapters, and an exceptional home office staff under the tireless and dedicated direction of Marilyn Dix Smith, ISPOR Executive Director, we made tremendous progress. All of our internal processes were re-worked and codified in our ISPOR Policies and Procedures Manual, in large measure due to the work of Hugh Tilson, Jim Smeeding, and Marilyn Dix Smith, along with Diana Brixner and Jean Paul Gagnon. This resulted in the creation of extraordinarily important ISPOR Chapters, ISPOR Networking and Discussion Groups, and several additional ISPOR Advisory Councils. I am particularly proud of the ISPOR Student Chapters, since this is where our future leadership resides. After several years, our by-laws were re-worked to incorporate all of our recent changes. The revised ISPOR By-laws are at our website. All of these changes, while seemingly unimportant and bureaucratic, were critical for our growth, since having a clearly defined infrastructure with ratified procedures and protocols is necessary for non-controversial progress forward.
We held a series of meetings with FDA and other organizations to discuss quality-of-life measurement, resulting in the first of our Working Paper Series. The quality-of-life regulatory guidance discussion paper is at the ISPOR website. A new committee was formed, the Health Policy Development Committee under the direction of Lou Morris. This committee worked on a response to FDAMA Section 114, as well as drafting a policy on how our Society should approach policy ratification. We have planned an outstanding policy-related conference on September 30, 1999, which will delve in more detail on drug trend issues and potential solutions, under the capable planning of Alan Lyles from Johns Hopkins University. Finally, we are contemplating our first internet-based conference to further explore the policy issues inherent in quality of life assessment.
As for membership in the Society, we have continued to grow. What is so significant, is that the past year has seen our ranks include nearly 30% ex-US members, with over 29 countries represented. We held our first meeting in Europe December 1998, and due to its incredible success, we made the strategic decision to have annual European meetings in November/December. The 2nd Annual European Conference is November 11-13, 1999 in Edinburgh, Scotland. We also initiated several European committees, including a Regulatory Affairs committee and an Education Committee. Our membership recently voted another European member to the Board of Directors, Adrian Towse, which extends our reach outside the U.S. Incredibly, we have added a Russian chapter to the fold. The president of the Russian Chapter, Pavel Vorobiev MD attended our annual meeting in Washington D.C.
I could continue to describe the innumerable accomplishments, the Russian version of our Lexicon, the expansion of the ISPOR Short Courses that were so successful at our 4th Annual Meeting, the one-of-a-kind inventory of degree-conferring and non-degree conferring pharmacoeconomic, outcomes research, and related programs worldwide we developed and are at the ISPOR website, and more. But what is more important to me was the personal dedication and spirit that so many put forward in the hope of making a difference. I would particularly like to recognize those members who are leaving our Board of Directors this year. Jim Smeeding, the 1997-98 President, truly advanced the Society forward through so many initiatives including the launch of our Journal, Value in Health. Lyle Bootman brought an academic slant and lifetime of invaluable experience to the Board. Tom Einarson brought his particular brand of Canadian spirit, compassion and understanding of all things meta-analyzed. Each of these three individuals is recognized for countless hours and weekends serving our Society. We are now truly a global society of people with a mission to ensure that consumers have access to good medicines and technologies, and to do so by rationalizing with the tools of our trade.
My hope for the Society and for our members is to keep several values in mind. Be concerned with the relevance of what you are doing, strive to innovate, and focus on quality. These values are especially important for us, since we are truly on the cutting edge of health care. Without these values, our field will be questioned or marginalized. Finally, maintain your sense of integrity in your work and your relationships this is not something to tradeoff. In a nascent field such as ours, we must be vigilant to 'do the right thing.'
It has truly been my pleasure leading the Society this past year, and I wish for all of you the very best. I leave you in the capable hands of our new President, Bryan Luce, who will take us to another level of rigor and energy, and I look forward to continuing my involvement in shaping our future.
1998-99 ISPOR President
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