Dean Smith

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Transcript Dean Smith

UM Student Chapter
Pharmacoeconomics and
Outcomes Research
Dean G. Smith, Ph.D.
October 10, 2005
Disclosure


Senior Associate Dean for
Administration
Professor of Health Management
& Policy
Prescription Drug “Inflation”
14%
12%
10%
8%
6%
4%
2%
0%
-2%1947
-4%
-6%
1954
1961
1968
1975
1982
1989
1996
2003
Disclosure

Co-Director, Michigan-Pfizer
Pharmacoeconomics & Outcomes
Research Fellowship Program
http://www.sph.umich.edu/hmp/admissions/pdfellowship.html
The mission of ISPOR is to translate
pharmacoeconomics and outcomes
research into practice to ensure that
society allocates scarce health care
resources wisely, fairly, and efficiently.
Further reading …
Designed specifically to meet the clinical
informational needs of managed care's
Pharmacy and Therapeutics Committee
Members.
Editors:
Michael E. Chernew, Ph.D.
A. Mark Fendrick, MD
Distribution of
Hypercholesterolemia - US
28%
31%
52%
17%
Am J Cardiol 1998;82:61-5.
<2F
CHD
2+RF
Drug Prices
Lovastatin (generic)
Lovastatin (Mevacor)
Fluvastatin (Lescol 20)
Atorvastatin (Lipitor)
Simvastatin (Zocor)
Rosuvastatin (Crestor)
Pravastatin (Pravacol)
$0.62
$1.28
$1.67
$2.18
$2.29
$2.42
$2.67
$2.03
$2.13
$2.31
$2.57
Online prices in the US: 10 mg, 90 tablets drugstore.com June 1, 2005,
Medi-Span March 31, 2005
Drug Prices

Some prices may change





Zocor - 2006
Pravacol - 2006
Lipitor - 2011
Crestor - 2016
Current analyses might think
about future prices
Hamilton DP, Winslow R. Do statins help prevent cancer? Few
tests slated. Wall Street Journal May 20, 2005, B1. B3.
Disclosure

Member,
Pharmacy Benefit Oversight
Committee
Formulary:
http://www.umich.edu/~benefits/plans/
drugs/formulary.htm
U Michigan Formulary
Tier 1
$7 Lovastatin (generic)
Tier 2 $14 Atorvastatin (Lipitor)
Pravastatin (Pravacol)
Rosuvastatin (Crestor)
Ezetimibe/Simvastatin (Vytorin)
Niacin/Lovastatin (Advicor)
Tier 3 $24 Lovastatin (Mevacor/Altoprev)
Fluvastatin (Lescol/Lescol XL)
Simvastatin (Zocor)
Pharmaceutical Economics
“The mean statin copayment had a
large effect on compliance. If the
copayment increases by $15, the
probability of compliance decreases by
10 percentage points.”


Doesn’t account for the process that might
occur with selection of a Tier 2 or Tier 3
agent.
Schultz, O’Donnell et al. Determinants of compliance with statin therapy
and LDL-C goal attainment in a managed care setting.
American Journal of Managed Care, May 2005.
Disclosure
Michigan
New Health Plan

Member, Board of Directors
Formulary:
http://www.molinahealthcare.com/
michigan/provider/formulary.html
Molina Michigan Formulary
Standard
Lovastatin (generic)
Lovastatin (Altoprev)
Atorvastatin (Lipitor 10 mg, 20 mg)
Ezetimibe/Simvastatin (Vytorin)
Prior Authorization
Atorvastatin (Lipitor 40 mg, 80 mg)
Drug Therapy
HOWEVER, price is not value
Claiming value requires a
comparison of costs and benefits



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Some purchasers care about value,
others only price per pill
If you care about value, then there's
the short-run LDL-C change or
guidelines/goals and the long-run
mortality/QALY
Cumulative Responders
% Responders
90
Atorvastatin
80
70
Simvastatin
60
50
Fluvastatin
40
30
Pravastatin
20
10
0
12
24
36
Week
48
54
Total Cost to LDL-C Target
2500
2000
1500
1000
500
0

*
Atorvastatin
Fluvastatin
Pravastatin
Simvastatin
* p < 0.01
vs. others
Smith, McBurney. An Economic Analysis of The Atorvastatin
Comparative Cholesterol Efficacy and Safety Study (ACCESS).
Pharmacoeconomics, 2003.
Willingness-to-Pay (NCEP)
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
R-10
A-10
A-40
A-80
0
2000
4000
6000
8000
10000
Miller, Smith, Jones. Cost Effectiveness of Rosuvastatin in Treating
Patients to Low-Density Lipoprotein Cholesterol Goals Compared With
Atorvastatin, Pravastatin, and Simvastatin (a US Analysis of the
STELLAR Trial). American Journal of Cardiology, 2005.
Questions
?