1. Prof. Md Sayedur Rahman Pharmacoeconomics: Bangladesh Perspective
Department of Pharmacology
Bangabandhu Sheikh Mujib Medical University

2. What is pharmacoeconomics?
Pharmacoeconomics is the branch of economics related to the most economical and efficient use of pharmaceuticals. Economic approaches are applied to pharmaceuticals to guide the use of limited resources to yield maximum value to patients, health care payers and society in general.

3. What are the aims of pharmacoeconomics?
Aim 1: Evaluation of the cost and effect of pharmaceutical products Aim 2: Optimization of the resource allocation in health sector

4. Cost-effectiveness Analysis
Pharmacoeconomics
Compare intervention with different efficacy and safety as well as different outcome
Cost expressed in monetary value
Effect expressed in natural units, eg., mm of Hg blood pressure lowering, lowering of pain in unit of VAS scale

5. Cost-effectiveness Analysis
Less More
Cost
Less effective
More cost
Less cost
More effective
Pharmacoeconomics
More
Effectiveness
Less

6. New Cancer Therapy Symptoms Drug X Drug Y Survival days 300 400
Pharmacoeconomics
Symptoms Drug X Drug Y
Survival days
Days sick of chemotherapy
Days sick of disease
TWiST
Time Without Symptoms of disease and subjective Toxic effects of treatment

7. New Cancer Therapy (cont.)
Pharmacoeconomics
50 patients each year (per hospital)
Medicine x: 50 x Taka 1,750 = Taka 87,500
Medicine y: 50 x Taka 2,000 = Taka 1,00,000
Medicine budget for x or y = Taka 50,000
Number of patient
Medicine x: Taka 50,000 / 1,750 = 28.5 patients
Medicine y: Taka 50,000 / 2,000 = 25.0 patients
Survival in days
Medicine x: 28.5 patients x 300 days = 8,550 days
Medicine y: 25.0 patients x 400 days = 10,000 days
Survival in TWiST
Medicine x: 28.5 patients x 190 TWiST = 5,415 days
Medicine y: 25.0 patients x 220 TWiST = 5,500 days

8. Cost-minimization Analysis
Pharmacoeconomics
Appropriate when alternative therapies have equal efficacy, safety, tolerability and have identical outcome, but different costs.
Estimates costs of an intervention, but not benefits
Choose the least cost alternative among equivalent efficacious alternatives

9. Cost-benefit Analysis
Pharmacoeconomics
Identification, measurement and comparison of the benefits and cost of therapeutic alternatives
Express benefit and cost in monetary unit

10. Cost-utility Analysis
Pharmacoeconomics
Method for comparing treatment alternatives
Focuses on increased quality of life
Measures an intervention’s effect on both quantitative and qualitative aspects of health

11. Quality Adjusted Life Year (QALY)
Pharmacoeconomics
How much a person have to pay to increase his/her life expectancy for each year, along with considering the quality of life
Calculation: 1 QALY= 1 year of life × 1 year of utility value

12. Disability Adjusted Life Year (DALY)
Pharmacoeconomics
A measure of health gap
Considers the proportion of disability and benefit of treatment by virtue of expenditure
Calculation:
DALY = YLL × YLD
YLL → Years of Life Lost due to premature mortality
YLD → Years of Life Lost due to Disability

13. Pharmacoeconomics
Pharmacoeconomics as a guiding principle for evaluation of medicine around the world

14. Australia
Pharmacoeconomics
Economic evaluation is one factor to be considered when making choices between competing therapeutic modalities

15. Belgium
Pharmacoeconomics
Calculation of Cost
Valuation of Outcome

16. Canada
Pharmacoeconomics

17. China
Pharmacoeconomics

18. Cuba
Pharmacoeconomics

19. Malaysia
Pharmacoeconomics

20. South Africa
Pharmacoeconomics

21. USA
Pharmacoeconomics
Though pharmacoeconomics has started it’s journey as a division in an academic institution like Harvard, that received very limited acceptance by the Government of USA!

22. Pharmacoeconomics as a research issue in medical science

23. Articles published with keyword ‘pharmacoeconomic’ in the Title/Abstract (searched in PubMed)
Pharmacoeconomics
2,384 articles!

24. Articles published with keyword ‘pharmacoeconomic’ in the Title/Abstract only in 2015 (searched in PubMed)
Pharmacoeconomics
110 articles!

25. Articles published with keyword ‘pharmacoeconomic’ and ‘Bangladesh’ in the Title/Abstract (searched in PubMed)
Pharmacoeconomics
No articles!!

26. Articles published with keyword ‘pharmacoeconomic’ in the Title/Abstract (searched in Google Scholar)
Pharmacoeconomics
2,630 articles!

27. Articles published with keyword ‘pharmacoeconomic’ in the Title/Abstract only in 2015 (searched in Google Scholar)
Pharmacoeconomics
96 articles!

28. Articles published with keyword ‘pharmacoeconomic’ and ‘Bangladesh’ in the Title/Abstract (searched in Google Scholar)
Pharmacoeconomics
No articles!!

29. Articles published with keyword ‘pharmacoeconomic’ in the Title/Abstract (searched in Banglajol)
Pharmacoeconomics
No article!

30. Pharmacoeconomics
Weightage/importance given on Pharmacoeconomics and related issues in the MBBS Curriculum of Bangladesh

31. Weightage given on ‘pharmacoeconomic’ issue in the MBBS Curriculum of Bangladesh
Pharmacoeconomics
Never mentioned!

32. Weightage given on ‘cost’ issue in the MBBS Curriculum of Bangladesh
Pharmacoeconomics
Never mentioned!

33. Weightage given on ‘price’ issue in the MBBS Curriculum of Bangladesh
Pharmacoeconomics
Never mentioned!

34. Weightage on ‘Pharmacoeconomics and related topics’ the Pharmacology portion of the MBBS Curriculum of Bangladesh
Pharmacoeconomics
Item Total Pharmacoeconomics related
Topics
Lectures
Tutorials
Practicals
Clinical Case
Obtained from the Baseline Study Conducted by Dr Nargis Akhter Chowdhury, for her thesis titled “Cost-Effectiveness Issue in the Under-graduate Medical Education Programs: Assessment of Weightage, Reflection in Prescribing and Effect of ICT-based Feedback”

35. Weightage ‘Pharmacoeconomics and related topics’ in MBBS Examination from 2010 to 2014
University Direct Indirect
Dhaka 0 % 5.43
Chittagong 0 %
Rajshahi 0 %
SUST 0 %
USTC 0 %
Gonobishwabiddyala 0 %
Obtained from the Baseline Study Conducted by Dr Nargis Akhter Chowdhury, for her thesis titled “Cost-Effectiveness Issue in the Under-graduate Medical Education Programs: Assessment of Weightage, Reflection in Prescribing and Effect of ICT-based Feedback”

36. MD (Internal Medicine) 0 % 0 % MS (General Surgery) 0 % 0 %
Weightage ‘Pharmacoeconomics and related topics’ in Postgraduate Examination of BSMMU from 2010/12 to 2014
Pharmacoeconomics
Course Direct Indirect
MD (Internal Medicine) 0 % 0 %
MS (General Surgery) 0 % 0 %
DCH 0 % 0 %
DGO 0 % 0 %
Obtained from the Baseline Study Conducted by Dr Nargis Akhter Chowdhury, for her thesis titled “Cost-Effectiveness Issue in the Under-graduate Medical Education Programs: Assessment of Weightage, Reflection in Prescribing and Effect of ICT-based Feedback”

37. Response of the teachers of BSMMU on query about Pharmacoeconomics/Cost-effectiveness (n=40)
Have you discussed about cost-effectiveness in the class?
Regular Occasional Never
5-10 Y 4/11 7/11 0/11
>10 Y 10/29 18/29 1/29
Obtained from the Baseline Study Conducted by Dr Nargis Akhter Chowdhury, for her thesis titled “Cost-Effectiveness Issue in the Under-graduate Medical Education Programs: Assessment of Weightage, Reflection in Prescribing and Effect of ICT-based Feedback”

38. Response of the teachers of BSMMU on query about Pharmacoeconomics/Cost-effectiveness (n=40)
Do you think the way cost-effectiveness mentioned in the Textbook is adequate?
Yes No
5-10 Y 0/11 11/11
>10 Y 0/29 29/29
Obtained from the Baseline Study Conducted by Dr Nargis Akhter Chowdhury, for her thesis titled “Cost-Effectiveness Issue in the Under-graduate Medical Education Programs: Assessment of Weightage, Reflection in Prescribing and Effect of ICT-based Feedback”

39. Response of the teachers of BSMMU on query about Pharmacoeconomics/Cost-effectiveness (n=40)
Do you ask about cost-effectiveness in the examinations?
Regularly Occasional Never
5-10 Y 0/11 4/11 7/11
>10 Y 3/29 17/29 9/29
Obtained from the Baseline Study Conducted by Dr Nargis Akhter Chowdhury, for her thesis titled “Cost-Effectiveness Issue in the Under-graduate Medical Education Programs: Assessment of Weightage, Reflection in Prescribing and Effect of ICT-based Feedback”

40. Response of the teachers of BSMMU on query about Pharmacoeconomics/Cost-effectiveness (n=40)
How do you evaluate the skill of Bangladeshi doctors about cost-effectiveness?
Excellent Good Lacking
5-10 Y 0/11 10/11 1/11
>10 Y 1/29 20/ /29
Obtained from the Baseline Study Conducted by Dr Nargis Akhter Chowdhury, for her thesis titled “Cost-Effectiveness Issue in the Under-graduate Medical Education Programs: Assessment of Weightage, Reflection in Prescribing and Effect of ICT-based Feedback”

41. Awareness about Pharmacoconomics
Pharmacoeconomics
Physicians are concerned mostly on the efficacy of the medicine with lesser attention on the cost and safety. It is assumed that the awareness of economic analysis among the prescribers, health managers and policy makers might be helpful to decide and choose the best option in order to ensure optimum utilization of resources.

42. Just Thinking About Cost can Bring Great Change
Pharmacoeconomics

43. Please stop before you write name of any medicine!
Pharmacoeconomics

44. WAIT: We are in the middle of a conference on iceberg avoidance
Watch out on Starboard !!
Pharmacoeconomics
WAIT: We are in the middle of a conference on iceberg avoidance
TITANIC

45. Pharmacoeconomics
Thank You