Jean Paul Gagnon

Key factors in the rising cost of new drug discovery and development

The public desire for new therapies, their increasing cost and the increased role of government as a payer for innovative new drugs all converge on the issue of the rapidly rising cost of new drug development — now thought to be greater than US

Feasibility of Symbolic Directions on Prescription Labels

800 million — and highlight the necessity for an efficient use of resources. With this in mind, here we review studies on the cost of developing new drugs and consider how this cost has, and could be, affected by the changing environment for pharmaceutical research and development.

The Patient-Pharmacist Interaction in Two Ambulatory Settings — It's Relationship to Patient Satisfaction and Drug Misuse

This project presents the results of a study designed to evaluate the usefulness of graphic labels in assisting functionally illiterate patients to understand how and when to take medication. The projects results indicate that comprehension of symbolic directions did not increase as rapidly as comprehension of typed directions. Symbolic directions did, however, reduce the variation in interpretation of directions among patients with a 0–4 grade education. Neither age, nor sex, nor the order of label presentation affected level of comprehension of typed or symbolic prescription labels. The results of this study indicate that use of symbols may not be the sole answer to the problem of assisting patients with inadequate reading abilities. Symbolic prescription directions should be evaluated before their use. Then, when used, they should be accompanied by oral reinforcement.

The Effects of Price Information on Physician Prescribing Patterns — A Literature Review

Seventy-five clinic outpatients were randomly assigned to a Satellite Pharmacy with a private consultation room or a centralized Traditional Pharmacy with an open-window setting. A comparison of the patient-pharmacist interaction and its relationship to the patients satisfaction with pharmacy services and his drug-taking behavior was measured by the use of two questionnaires. A significant difference was found in the quantity of consultation activities performed by the pharmacists in the two settings. Patients were significantly more satisfied with the Satellite Pharmacy and seemed to favor the private setting over the open-window. Patient satisfaction was significantly correlated with the waiting time, the amount of time spent with the pharmacist, the total activities received during the interaction, and satisfaction with hospital services in general. Medication errors were not significantly different for the two patient groups when measured by verbal reports but compliance scores were significantly different for those patients taking drugs for which a tablet count could be done. Although analysis of the data showed a significant difference for only one measure of drug-taking behavior, improvement of drug use as a result of the interaction with the pharmacist in the Satellite Pharmacy was suggested. Compliance scores for regularly scheduled drugs correlated with the financial status of the patient, total interaction activities, and interaction time. Financial status, satisfaction with the drug, and the day of the second interview were significantly correlated with the PRN compliance scores.

Pharmacoeconomics: Proposed Drug-Drug Cost Effectiveness Methodology

Rising expenditures for drugs under Medicare, Medicaid, and other federally funded programs have prompted the Department of Health, Education and Welfare to adopt regulations aimed at achieving cost containment. The Maximum Allowable Cost (MAC) regulations exemplify this effort. One of the components of these regulations proposes to generate added cost savings by influencing physicians to prescribe lower cost drugs to a greater extent. This would result from the provision of drug cost information to the physicians. The literature was reviewed in an attempt to predict the impact that drug cost information might have on the physicians prescribing decision and reimbursement costs. The conclusion reached is that physicians will not incorporate price information into the prescribing decision to the extent necessary for the achievement of cost savings. An alternative strategy is proposed which utilizes pharmacists to provide prescribers with drug information. This strategy is based on the efficacy of the drug industrys detailmen in providing drug information, the availability of trained manpower, and empirical evidence supporting this activitys cost containment potential. Finally, the need for evaluative research in five areas is suggested prior to the implementation of programs similar to that proposed by HEW.

The Construction and Testing of an Image Questionnaire

The advent of prospective reimbursement in hospitals has forced hospital administrators, pharmacy directors, and pharmacy and therapeutic committees to carefully compare the cost and benefits of similar drugs. Accomplishing this task is difficult. This paper reviews the literature on drug-drug cost effectiveness procedures and outlines a methodology that might be used to contrast and compare two drugs with similar therapeutic outcomes. The data to conduct this analysis can be obtained from published articles on clinical studies and company sources and entered into a microcomputer electronic spreadsheet. The study discusses the implications and use of cost effectiveness analysis to evaluate drugs by hospital formulary committees.

A Study of the Relationships of Drug Dosage Form, Therapeutic Class and Pharmaceutical Services with the Gross Margins on Prescription Drugs

This paper reports on the construction and testing of a survey instrument which could be used by pharmacy retailers to conduct image analysis. After investigating the use of multidimensional scaling in combination with semantic scales and extensive pretesting involving the use of scale discrimination and multivariate techniques, the relevant image components were identified and a self-administered questionnaire was constructed and tested. It was concluded that the resulting instrument was not only valid and useful to pharmacy retailers but demonstrated methods which were potentially applicable to other image analysis.

The Viability of the Lost Letter Technique

This study evaluated the effects of drug dosage form, therapeutic class, and available pharmaceutical service on the gross margins of prescriptions. Actual prescription ingredient costs reflecting both wholesale discounts and warehouse costs were computed for each of 300 prescriptions from 29 pharmacies. These ingredient costs together with prescription prices were used to calculate the gross margins for the sample of prescriptions. The markups for the five dosage form categories and two therapeutic classes were analyzed by using analysis of variance and covariance techniques. Regression methods were used to study the effects of delivery, patient record cards, and account receivable services on average prescription gross margins per pharmacy. The results of the statistical tests revealed that when prescription ingredient cost is controlled therapeutic class does not effect prescription gross margins while drug dosage form does. Only delivery service, of the three services regressed, was found to be significantly related to prescription gross margins.

Results of a preliminary study of consumer attitudes on hypertension screening by pharmacists.

Summary The lost letter technique was used to investigate consumer attitudes on two potential pharmaceutical services: taking of blood pressures and performing physical examinations in pharmacies. The methodology consisted of “losing” approximately 500 letters around three pharmacies with addresses that indicated favorable or unfavorable attitudes toward these services. The reliability of the lost letter was gauged through the use of simultaneously administered 300 in-store questionnaires investigating the same issues. Questionnaire respondents were opposed to both services, but only significantly so in the case of physical examinations. However, the lost letter technique results on both issues were nonsignificant; i. e., respondents were neither for nor against such services. In view of the questionnaire results, it may not be possible to replicate the findings of the lost letter technique. A possible problem with this methodology is that it may be insensitive to noncontroversial issues. When this techni...

A comparison of maintenance and nonmaintenance outpatient prescription directions, durations of coverage, and costs per day.

HYPERTENSION, OR HIGH BLOOD PRESSURE, is a disorder which affects an estimated twenty-three million Americans, fifteen percent of the adult population. It is also the primary cause of approximately 60,000 deaths and a contributing cause in all heart attacks and strokes, estimated to be more than 1.5 million per year in the United States.» The disease can be easily and quickly detected, and can be treated effectively in most cases. However, many individuals with hypertension are not being treated, or are not being treated successfully. It appears that the failure of therapy to meet the severity and extent of the disease can be attributed to two main problems: (1) the difficulty in identifying the hypertensive patient, and (2) the lack of patient compliance with drug therapy.·· Hypertension in its early stages is largely asymptomatic. As a result, individuals having the disease are