1. Health Services Research and Practice: Pharmaceuticals Andy Stergachis, Ph.D. R.Ph. Epidemiology and Pharmacy

2. Topics n Medication Use n Variations in Drug-Related Services n Pharmacoepidemiology & Drug Safety

3. Rx Expenditures: selected countries $US Bil Source: IMS HEALTH: MIDAS, 2001 * Pharmacy only ** Hospital only Sales Rx

4. Rx Spending Per Capita Source: OECD Health Data, 1999 Rx

5. Variations in Drug-Related Services n Pharmacies and pharmacists n Financing n Advertising and promotion n OTCs and drug schedules n Drug approval n Complementary medicine

6. 71%11%12%4%2% 6,225 935 1,067 328 167 PRECLINICAL PHASE IPHASE IIPHASE III PRE-REG Source: IMS Lifecycle CD ROM December 2001 2001 Global Pipeline To December 2001  8,722 Products New Product s

7. Sources of Risk from Medical Products

8. Pharmacoepidemiology as a Continuum n Surveillance/Signal Generation u Adverse event reports n Verify/Confirm and Quantify Risk u Case-control and cohort studies n Improved Patient Care and Regulatory Decision Making u Risk-to-benefit

9. Issues n Affordability, access and equity n How safe is safe enough? n Variations in pharmacy practice n Variations in regulatory agencies n Drug reimportation concerns n Patterns of use, e.g., antimicrobial resistance

10. More Information n www.fip.org: n Humanitarian Organizations (for example): n Other Organizations (eg. pharmacoepi.org) n stergach@u.washington.edu