FARMAKOEKONOMI

VITIS VINI FERA R.U

Kontrak Pembelajaran
Komposisi nilai:
30 % tugas terstruktur
30 % ujian mid
30 % ujian akhir
10 keaktifan?
Bobot nilai: A: 80,00; B: 66,00-79,99;
C: 56,00-65,99; D: 46,00-55,99; E: 46,00

Materi Perkuliahan dan Tugas

Kompetensi Mata Kuliah: Mahasiswa mampu menjelaskan
analisis farmakoekonomi untuk membandingkan pelayanan
kesehatan yang paling efektif
Pendahuluan: Pentingnya mata kuliah farmakoekonomi,
Prinsip Dasar Farmakoekonomi
Analisis Farmakoekonomi (cost minimization analysis/CMA,
cost effectiveness analysis/CEA, cost utility analysisi/CUA, cost
benefit analysis/CBA)
Pengukuran Kualitas Hidup Dalam Evaluasi Obat
Analisis Keputusan dan Evaluasi Farmakoekonomi
Studi Kasus

Pendahuluan
Apoteker Sebagai Bagian Dari Sistem Pelayanan Kesehatan

DOKTER

PERAWAT
PELAYANAN
MEDIS

PASIEN

ASUHAN
KEPERAWATAN

PELAYANAN
FARMASI

APOTEKER

PELAYANAN
GIZI

AHLI GIZI

PELAYANAN
KESEHATAN
LAINNYA

PROFESIONAL
LAINNYA

KONTAK
PROFESIONAL

HEALTH
CARE

OUTCOME

CLINICAL

HUMANISTIC

ECONOMIC

Economics: science of scarcity and choice

RESOURCES

CHOICES

NEEDS

PRIORITY

WANTS

DEMANDS

we want to make the

best use of them.

SUPPLY

If you have only 15,000 Rp.

You have choices of lunch,
either

or

How do you make decision?

7

As a pharmacist at community
pharmacy
There is a child getting sick with URI
There are choices of
or

upper respiratory infection

How do you select?

8

What you may concern.

Does it work (symptom vs efficacy)?
What is side effect?
What would the patient feel (taste, compliance)?

How much does it cost (concerning on patients

economic status/ affordability)?
9

Your Job : As a hospital pharmacist,

you have to provide evidence
for hospital administrative board
to incorporate COX-2 for osteoarthritis
into hospital formulary.

10

IF; scenario A. Which one do you select?

Factor

NSAID

COX-2

Efficacy

lower

higher

- gastrointestinal

higher

lower

- cardiovascular

higher

lower

higher

lower

Side effect

Drug cost/ 3 months

IF; scenario B. Which one do you select?

Factor

NSAID

COX-2

Efficacy

higher

lower

- gastrointestinal

lower

higher

- cardiovascular

lower

higher

lower

higher

Side effect

Drug cost/ 3 months

11

Preliminary review

Factor

NSAID

COX-2

Efficacy

lower

higher

- gastrointestinal

higher

lower

- cardiovascular

higher/ lower

lower/ higher

lower

higher

Side effect

Drug cost/ 3 months

Which one is better?

NSAID or COX-2

Which one is cheaper?

NSAID or COX-2

Which one will you select? NSAID or COX-2

12

In sum
We have limited money/ resources.
We have choices of how to use the money.
When we use money for one choice, we lose
opportunity to use for another choice.
We have to make decision on choosing for a more
worthwhile of money used.
Outcomes of choices are multiple ones.
We need a method to combine outcomes before
comparing between the choices.
13

DISEASE BURDEN
Economic Burden
to the Society
Obat Yang Rasional: Safe, Effective,
Acceptable PENINGKATAN
KESEJAHTERAAN PASIEN
ACCESSIBLE

Definisi
Pharmacoeconomics
The description and analysis of
the cost of drug therapy to
health care systems.
Ph.eco research Identifies, measures, and
compares the costs (resources consumed)
and consequences (clinical, economic,
humanistic) of pharmaceutical products and
services.

Pharmacoeconomics:
Pharmacoeconomics may be defined as balancing the
cost with the consequences (outcomes) of
pharmaceutical therapies and services.
As a type of outcomes evaluation, pharmacoeconomics
looks beyond just the direct cost of a pharmaceutical by
including its impact on total health resource utilization
and costs.
Reeder CE. Overview of pharmacoeconomics and pharmaceutical outcomes
evaluations. Am. J. Health Syst. Pharm. 1995;52(suppl_4):S5-8.

 Health economics is a discipline that analyses

the economic aspects of health and health
care and that usually focuses on the costs
(inputs) and the consequences (outcomes) of
health care interventions using methods and
theories from economics and medicine.
Berger et al 2003.
Economic evaluation is the comparative
analysis of alternative courses of action in
terms of both their costs and consequences.
Drummond et al 2005.
EE_TP_theory.pptx

17

Why study Pharmacoeconomics?

18.0
16.0
14.0
12.0
10.0
8.0
6.0
4.0
2.0
0.0

Canada
France
Germany
Japan
United Kingdom

Year

05
20

00
20

95
19

90
19

85
19

80
19

75
19

70

United States

19

% GDP

Health Expenditures as a % of GDP by Country

But when it comes to outcomes

Life Expectancy at Birth by Country
84
Canada

78

France

75

Germany

72

Japan

69

UK

66

US

63
60

19
61
19
66
19
71
19
76
19
81
19
86
19
91
19
96
20
01
20
04

Years of Life

81

YEAR

So
What are we doing wrong?
And how can we improve our
performance?
by spending less
getting better outcomes

Pharmacoeconomics allows us
to compare the economic resources consumed
(inputs) to produce the health and economic
consequences of products or services
(outcomes).
INPUTS
Economic
Resources

OUTCOMES
Health and Economic
Consequences

Outcomes in health care (ECHO model)

Technology

Pathogens

Patient

Humanistic

Outcomes

Clinical

Economic

Socio-economic factors

Healthcare facilities
Health financing
22

Outcomes of Health Care

Clinical outcomes;
mortality, morbidity, disability, clinical end points e.g.
blood pressure, serum glucose concentrations.
Humanistic outcomes;
effects on physical, social, and emotional well-being e.g.
patient satisfaction, QALYs (Quality-adjusted life years).
Economic outcomes;
impact on total health resource utilization and cost e.g.
savings (change) on treatment cost due to clinical
pharmacy services.
23

Economic evaluation (EE)

The comparative analysis of alternative
courses of action in terms of both their costs
and consequences.
Consequences A
Program A
Cost A
Choice
Cost B
Program B
EE_TP_theory.pptx

Consequences B
24

Principles of EE
Effectiveness
of the option

Higher

Lower

Costs of the option

Higher
EE
Reject

Lower
Accept
EE
(rare case)

EE_TP_theory.pptx

25 25

Steps for conducting a PE Analysis

1. define the problem
2. identify the perspective and alternative
interventions to be compared
3. identify and measure outcomes of each
alternative
4. identify, measure and value costs of all
alternatives
5. use discounting and sensitivity analysis
when appropriate

1. Define the problem and state the objective

Identify the disease state and what aspect you
want to deal with.
i.e. What is the most cost effective method for
controlling glucose in the treatment of type II
diabetes?

2. Identify the perspective

that is, who will be utilizing the information to
make what decisions.
This will guide you in choosing the relevant
costs and benefits.

Perspectives
1.
2.
3.
4.
5.

Patient
Health Practitioner
Hospitals or Hospital systems
Third-Party payers
Societal

Patient Perspective
Examples of costs that directly affect
the patient include:
Out-of-Pocket costs
lost income
transportation

Relevant Consequences are:

Therapeutic effectiveness
Adverse events
Quality of Life (QOL)

Health Practitioner
Costs to physicians may include:
Hospitalization
Pharmacy
Personnel
Supplies
Consequences of interest are:
Therapeutic effectiveness
Adverse events

Hospitals
Costs include:
Hospital stay costs
Treatment of adverse events & complications

Consequences of interest:
Therapeutic effectiveness
Adverse events

Third-Party Payer
Costs of care incurred for covered services
which may include:
Hospitalization
Pharmacy
Nursing home care
Consequences of interest
None

Societal
All possible costs including lost productivity
All possible consequences including QoL, & life
years.

Cost factors are becoming more

important
From whose perspective?
Health provider?
Patient?
Societal (masyarakat)?
Payer?

Biaya (cost) didefinisikan sebagai besarnya

sumber daya (resources) yang dikonsumsi
Biaya produk atau pelayanan merupakan nilai
moneter dari sumber daya yang dikonsumsi
dalam menghasilkan barang atau jasa
Sumber daya antara lain: sdm, sarana prasarana,
gedung

Macam-macam biaya

Biaya Langsung (Direct Cost)

Biaya Tak Langsung (Indirect Cost)
Biaya Tak Teraba (Intangible Cost)
Biaya Tetap (Fixed Cost)
Biaya Tidak Tetap (Variable Cost)
Biaya rata-rata (Average Cost)
Biaya marjinal (Marginal Cost)
Cost of illness
Cost of therapy

Quote of the day

Badai membuat pohon memiliki

akar yang lebih dalam dan kuat
(Dolly Parton, Singer, Amerika)