Med Decis Making - US-Based Drug Cost Parameter Estimation for Economic Evaluations.

Tópicos

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Resumo

TRODUCTION: In the United States, more than 10% of national health expenditures are for prescription drugs. Assessing drug costs in US economic evaluation studies is not consistent, as the true acquisition cost of a drug is not known by decision modelers. Current US practice focuses on identifying one reasonable drug cost and imposing some distributional assumption to assess uncertainty.METHODS: We propose a set of Rules based on current pharmacy practice that account for the heterogeneity of drug product costs. The set of products derived from our Rules, and their associated costs, form an empirical distribution that can be used for more realistic sensitivity analyses and create transparency in drug cost parameter computation. The Rules specify an algorithmic process to select clinically equivalent drug products that reduce pill burden, use an appropriate package size, and assume uniform weighting of substitutable products. Three diverse examples show derived empirical distributions and are compared with previously reported cost estimates.RESULTS: The shapes of the empirical distributions among the 3 drugs differ dramatically, including multiple modes and different variation. Previously published estimates differed from the means of the empirical distributions. Published ranges for sensitivity analyses did not cover the ranges of the empirical distributions. In one example using lisinopril, the empirical mean cost of substitutable products was $444 (range = $23-$953) as compared with a published estimate of $305 (range = $51-$523).CONCLUSIONS: Our Rules create a simple and transparent approach to creating cost estimates of drug products and assessing their variability. The approach is easily modified to include a subset of, or different weighting for, substitutable products. The derived empirical distribution is easily incorporated into 1-way or probabilistic sensitivity analyses.

Resumo Limpo

troduct unit state nation health expenditur prescript drug assess drug cost us econom evalu studi consist true acquisit cost drug known decis model current us practic focus identifi one reason drug cost impos distribut assumpt assess uncertaintymethod propos set rule base current pharmaci practic account heterogen drug product cost set product deriv rule associ cost form empir distribut can use realist sensit analys creat transpar drug cost paramet comput rule specifi algorithm process select clinic equival drug product reduc pill burden use appropri packag size assum uniform weight substitut product three divers exampl show deriv empir distribut compar previous report cost estimatesresult shape empir distribut among drug differ dramat includ multipl mode differ variat previous publish estim differ mean empir distribut publish rang sensit analys cover rang empir distribut one exampl use lisinopril empir mean cost substitut product rang compar publish estim rang conclus rule creat simpl transpar approach creat cost estim drug product assess variabl approach easili modifi includ subset differ weight substitut product deriv empir distribut easili incorpor way probabilist sensit analys

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