Principles of pharmacoeconomic analysis: the case of pharmacist-led interventions

In the past years, several factors such as evidence-based healthcare culture, quality-linked incentives, and patient-centered actions, associated with an important increase of financial constraints and pressures on healthcare budgets, resulted in a growing interest by policy-makers in enlarging pharmacists' roles in care. Numerous studies have demonstrated positive therapeutic outcomes associated with pharmaceutical services in a wide array of diseases. Yet, the evidence of the economic impact of the pharmacist in decreasing total health expenditures, unnecessary care, and societal costs relies on well-performed, reliable, and transparent economic evaluations, which are scarce. Pharmacoeconomics is a branch of health economics that usually focuses on balancing the costs and benefits of an intervention towards the use of limited resources, aiming at maximizing value to patients, healthcare payers and society through data driven decision making. These decisions can be guide by a health technology assessment (HTA) process that inform governmental players about medical, social, and economic implications of development, diffusion, and use of health technologies - including clinical pharmacy interventions. This paper aims to provide an overview of the important concepts in costing in healthcare, including studies classification according to the type of analysis method (e.g. budget-impact analysis, cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis), types of costs (e.g. direct, indirect and intangible costs) and outcomes (e.g. events prevented, quality adjusted life year - QALY, disability adjusted life year - DALY). Other key components of an economic evaluation such as the models' perspective, time horizon, modelling approaches (e.g. decision trees or simulation models as the Markov model) and sensitivity analysis are also briefly covered. Finally, we discuss the methodological issues for the identification, measurement and valuation of costs and benefits of pharmacy services, and suggest some recommendations for future studies, including the use of Value of Assessment Frameworks

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Pharmacoeconomics and immunotherapy.

Pharmacoeconomics is a relatively new discipline whose scope is to describe, measure and compare costs and outcomes of alternative healthcare programmes from a variety of perspectives. This article is aimed at describing the various types of pharmacoeconomics analyses, indicating what types of costs and outcomes could be measured within each type of study, summarising the value of modelling techniques in pharmacoeconomics studies and finally suggesting what kind of pharmacoeconomic research can usefully be conducted in order to appreciate the burden of respiratory allergic disease and to evaluate the economic impact of health technologies that can effectively be used to manage it. Pharmacoeconomics is a relatively recent discipline whose use has been spread by the necessity of decision makers in most industrialised countries, to gain understanding of the economic effect of medical technologies in parallel with their clinical performance: only a wider use of the techniques of pharmacoeconomics analysis, together with an increasing willingness of the scientific community to understand the mechanics and appreciate the added value of pharmacoeconomics analysis, can help the discipline to proceed and provide further improvement to the healthcare system and to the society.