Konsep, Tipe Evaluasi Farmakoekonomi,

Perspektif dan Komponen Biaya

Apt. Didik Setiawan, Ph.D.
- Faculty of Pharmacy,
- Center for Health Economic Studies,
Universitas Muhammadiyah Purwokerto, Purwokerto, Indonesia
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 Universal Health Coverage (UHC)

current pooled funds is always limited

need a budget allocation methods

Health Economic Evaluation

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 Health Economic Evaluation (Pharmacoeconomics)

provide information (evidence) to decision makers

to maximize health benefits by efficient use of
available resources (limited budget)

Health economic evaluation (Pharmacoeconomics)

is two dimensional analysis from two (or more)
alternatives of health technology
• two dimension: input (cost) and output. (Health, monetary
(cost), humanistics)
• Health technology: drugs, medication technology, diagnostic
tools, prevention strategy (program)

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 Cost Effectiveness Plane (CEP)
Willingness to pay
/ Threshold

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 Soal Ilustrasi

• Seorang apoteker di komite/tim farmasi dan terapi menerima 3 usulan

obat baru (obat B1, B2, dan B3) untuk penyakit stroke dari departemen
penyakit dalam. Ketiga obat tersebut berpotensi untuk menggantikan
keberadaan obat A di dalam formularium rumah sakit.
• Hasil studi farmakoekonomi yang diserahkan oleh pengusul menunjukkan
data-data sebagai berikut Drugs Costs ($) Outcomes (QALYs)
A 10,000 0.75
B1 10.500 0.83
B2 9.800 0.80
B3 10.800 0.78

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 How cost effectiveness analysis works?

Outcomes
Drugs Costs ($)
(QALYs)
A 10,000 0.75
B1 10.500 0.83
B2 9.800 0.80
B3 10.800 0.78

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 How cost effectiveness analysis works?

Outcomes
Drugs Costs ($)
(QALYs)
A 10,000 0.75
B1 10.500 0.83
B2 9.800 0.80
B3 10.800 0.78

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 How cost effectiveness analysis works?

Outcomes
Drugs Costs ($)
(QALYs)
A 10,000 0.75
B1 10.500 0.83
B2 9.800 0.80
B3 10.800 0.78

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 Incremental Cost Effectiveness Ratio (ICER)

𝐶1 − 𝐶0 Biaya (I$) QALYs

Selisih
ICER (I$)
𝐼𝐶𝐸𝑅 = Biaya (I$) QALYs
𝐸1 − 𝐸0
Obat A 10,000 0.75 Referensi Referensi Referensi
Obat B1 10,500 0.83 500 0.08 6,250
- The unit of ICER? Obat B2 9,800 0.80 -200 0.05 -4,000
- How to interpret ICER?
Obat B3 10,800 0.78 800 0.03 26,667

Decision maker needs a cut off points or threshold called willingness to pay (WTP)

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Willingness
to pay
 Decision Making Process

B1 B2 B3
WTP Threshold
(ICER I$6,250) (ICER -I$4,000) (ICER I$26,667)
I$5,000,- Reject Accept Reject
I$10,000,- Accept Accept Reject
I$20,000,- Accept Accept Reject
I$30,000,- Accept Accept Accept

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 Tipe Luaran dan Evaluasi
Farmakoekonomi

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 Health economic outcomes

Clinical

Humanistic Economic

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 Clinical outcomes

Health technology Intermediate outcomes Endpoint outcomes

Lower incidence of stroke, heart attack, or death

Antihypertenson Lower blood pressure
due to hypertension
Increase of HPV-specific Lower incidence and mortality rate due to
HPV vaccine
antibody (immunogenicity) cervical cancer
The increase of CD4 and CD8 Low incidence or new infection in the
Antiretroviral
level population, lower death due to HIV-AIDS
Analgetic - Pain is releived

Family planing Number of contraception

Birth rate
program receptor

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 Economic outcomes

• Usually economic outcomes are converted from clinical outcomes

– Cost per patient avoided

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 Economic Outcomes

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 Humanistic Outcomes

• Health - Quality of life (QoL) – Health related Quality of Life (HrQoL)

• Quality Adjusted Life Years
– Utility 1

A
0,8

Kualitas hidup
0,6
B
0,4

0,2

0
0 2 4 6 8 10
Tahun

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 Questionnaire

• Disease or condition specific questionnaire

– More detail for a specific condition
– EORTC QLQ 30,
• Generic questionnaire
– Can be implemented for wide range of states
– EQ-5D, SF-36 etc

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 Analisis Farmakoekonomi

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 Types of Economic Evaluation
input outcome Result
Cost Effectiveness Cost Clinical Outcome. Cost per unit of consequences.
Analysis (CEA) E.g. life year gain on cancer, heart Eg. Cost per LYG,
attack reduction on hypertension, Cost per heart attach prevented,
blood glucose reduction on DM2 Cost per blood glucose level reduction

Cost Utility Analysis Cost Utility, QoL, or QALYs Cost per unit of consequences.
(CUA) Eg. Cost per QALYs

Cost Benefit Analysis Cost As for CEA but valued as money Net cost or cost benefit ratio
(CBA)

Cost Minimization Cost Considered equal Least cost alternative

Analysis (CMA)

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 Biaya dalam studi farmakoekonomi

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 Direct Cost

• all costs due to resource use that are completely attributable to the use of
a health care intervention or illness
– Direct medical cost
• Medicine, laboratory, professional fee, hospitalization, etc
– Direct non-medical cost
• Transportation, additional room, parking, additional food, etc

• What is the source of these information?

• How to obtain the information?

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 Direct Medical Cost (Primary Source)

Data dari billing/tagihan atau SIRS

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 Direct non-Medical Cost (Primary Data)

Data dari
wawancara
pasien

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 Direct Non Medical Cost (Primary Data)

Data dari
wawancara
pasien

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 Indirect cost (Primary Source)

• All cost that are indirectly spent by the patients or relatives due to illness
(ex. Productivity loss)
– Human capital approach, based on monthly income
• Monthly income / 30 days

• What is the source of information?

• How to obtain the information?

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 Indirect Cost (Primary Data)

Data dari
wawancara
pasien

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 Data Source (Primary Data)
• Biaya tidak langsung: Human capital approach
• A monetary value on loss of health as the lost value of economic productivity
due to ill health, disability, or premature mortality
– Calculate using income-based method
– Multiply the number of days with the daily income
– In Indonesia
• GDP, minimum regional income (UMR), observational/interview
• Example:
– Monthly income 3,000,000
– LoS 10 days
– Productivity loss = (3,000,000/30days) x 10 days
= 1,000,000
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 Data source (Secondary Data)

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 Intangible cost

• An unquantifiable cost relating to an identifiable source (illness)

• What is the source of these information?

• How to obtain the information?

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 Perspectives vs cost
Perspectives
Cost category
Patient Provider Payer Societal

Direct Medical Cost

• Health care cost (medicine, hospitalization, √ √ √ √
professional fee etc)
• Cost sharing √ x x √
Direct non-medical Cost
• Transportation, parking, additional food, etc √ x x √
Indirect Cost
• Prooductivity loss √ x x √
Intangible cost √ x x √

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Which perspective should you choose?

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 Didik Setiawan, PhD., Apt
Email: d.didiksetiawan@gmail.com
WA: +31 631 254575
Phone: 081 226 700 119
www.ches.ump.ac.id

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