William F. McGhan

Pharmacoeconomic Research and Clinical Trials: Concepts and Issues

The purpose of this article is to provide an overview of the emerging discipline of pharmacoeconomics. Specific methodologies and terms are defined. Pharmacoeconomic research is described, related to, and contrasted with clinical drug trials. Additionally, we present a brief overview of the general steps taken designing a pharmacoeconomic study. Finally, several issues centering around pharmacoeconomic analysis are presented for discussion and debate. The need for high-quality pharmacoeconomic research is stressed along with the need for appropriate education of individuals trained in the health sciences.

Use of histamine2-receptor blocking agents and sucralfate in a health maintenance organization following continued clinical pharmacist intervention.

The effect of continued clinical pharmacist intervention on the proper use of histamine2-receptor blocking agents and sucralfate in a health maintenance organization was studied. New prescriptions written for Cimetidine, famotidine, ranitidine, and sucralfate in January 1986 (preintervention), October 1986 (postintervention), and February 1987 (follow-up), and the medical record of each patient were analyzed for appropriateness using approved criteria. Clinical pharmacist intervention occurred throughout the study. There was a significant decrease (p < 0.005) in the rate of inappropriate prescribing in the postintervention (42.4 percent) and follow-up (48.7 percent) periods versus the preintervention period (81.5 percent), and in the average number of refills authorized per patient in the postintervention (1.2 ± 1.54) and follow-up (1.3 ± 1.00) periods versus the preintervention period (3.0 ± 3.67). There were no significant differences in these areas between the postintervention and follow-up periods (p > 0.05). A benefit-to-cost ratio of 4.3:1 was generated from this study which demonstrated that continued clinical pharmacy interventions can have a positive, cost-effective impact on the proper use of these commonly prescribed medications.

A Perspective on the Cost-Benefit of Drug Therapy

AbstractCost-benefit analysis is an important tool in assessing the impact of drugs on society. The purpose of this paper is to assess the cost-benefit of drugs to society and specifically to consider whether it is cost-beneficial for insurance and entitlement programs to include drug coverage in their health benefits package.Although prescription and over-the-counter drugs represent only 7.5 percent of total health care costs, drugs have been responsible for dramatic improvements in the health status of the public in this country.If we had the same diseases and mortality rates in recent years that we had at the turn of the century, we would have foregone billions of dollars annually due to loss of life and loss of work days. Our calculations demonstrate that even if drugs accounted for only 10 percent of the improvement in mortality and morbidity figures, the benefits of drugs definitely exceed the annual expenditures (costs) for drugs.The evidence indicates that it is very cost-beneficial for employers,...

Prescribing Intention and the Relative Importance of Drug Attributes

This study utilized the Fishbein Behavioral Intention Model as a conceptual framework to compare health maintenance organization (HMO) and fee-for-service (FFS) physicians. A mail questionnaire was used to obtain data and information from random samples of HMO (n = 73; 50% response) and FFS (n = 49; 33% response) physicians in the Phoenix and Tucson metropolitan areas. No differences were found between the two groups of physicians regarding the Fishbein variables: prescribing intention, importance of attributes, attribute beliefs, and subjective norms. The Fishbein Model was found to explain a significant portion of the variance in prescribing intentions of the HMO and FFS physicians.

Drug Recalls and Court Actions: A Comparison of Research-Intensive and Nonresearch-Intensive Pharmaceutical Firms

AbstractThe rate and volume of product recalls of the large, research-intensive (RI) pharmaceutical firms (23 firms that account for at least two-thirds of United States drug sales and 80% of research and development expenditures) was compared to that of the remaining, generally nonresearch-intensive (NRI) firms. Data were compiled on all drug recalls occurring between 1970 and 1978 (including over-the-counter products, Class I, II, and III recalls, and citations for failure to file NDAs) by combining the data used as the basis for three previous studies. Analysis of these data indicated that, while larger (RI) firms have a higher number of recalls per firm, the relative amount of material recalled as a percent of material produced is actually less than that of smaller (NRI) firms. When all firms are dichotomized as RI or NRI, the NRI firms had 1.5 times more of their product recalled; accounted for 86% of all recalls; had a seven-fold greater rate of involuntary recalls (22% of their total); and accounte...