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 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 ?