Introduction
Introduction
Great strides have been made in the practice of medicine over the past 20 years. We have developed ways to use antibodies to provide targeted delivery of cytotoxic agents. Lasers are used to perform complex surgical procedures with minimal host intrusion. Techniques have been developed that cloak potent but extremely toxic antimicrobials, allowing them to be safely administered to patients. We even have mapped the entire human genomean accomplishment that one day may result in the development of incredibly accurate diagnostic tests and gene therapies. Unfortunately, progress has not come without a price. Over the same time in which we have witnessed this leap in medical knowledge and technology, we also have seen a tremendous increase in the cost of health care. All clinicians want to provide their patients with the best therapies possible. Unfortunately, this often translates into prescribing the newest and most expensive agents available. As a result of this practice, significant economic pressures have been placed on health care systems. The dilemma that we now face is how to use our limited health care resources in the most efficient manner without compromising patient care.
The science of pharmacoeconomics was born out of the need to balance patient care with health care resource management. Various methods have been developed under the umbrella of pharmacoeconomics that allow clinicians and decision makers to systematically assess the safety and efficacy of a drug or procedure and evaluate the impact of utilization on patient-related costs. Acceptance of data generated from pharmacoeconomic studies has suffered somewhat as the result of methodologic disagreement, perspective biases, and perception that pharmaco-economic studies were developed solely for the purpose of marketing. Many of the criticisms stem from the use of estimations for event rates and costs, which introduce a level of subjectivity and thus potential bias into studies. In response to these limitations, investigators began to develop methods that allow for truer assessment of health care resource utilization. Although more labor intensive, data generated tend to reflect a more accurate summary of real-life scenarios rather than cost estimations.
In this supplement, we have attempted to describe and provide examples of relatively novel pharmacoeconomic approaches. In the first article, we introduce the concept of health care utilization as a constantly changing or dynamic parameter. The study of changing patterns of health care utilization over the course of disease management has been referred to as econodynamics. In the next article, Dr. Zhiming Li and colleagues explore the use of length of stay as a marker of treatment efficacy. Factors affecting the length of stay, both treatment related and unrelated, are evaluated, and their impact on variable validity is discussed. Drs. Yehuda Carmeli and Essy Mozaffari discuss the use of insurance claims databases as a method for assessing resource utilization associated with outpatient drug therapy. In the last article, Dr. Alan Tice and colleagues discuss the use of novel databases such as the United States Outpatient Parenteral Antibiotic Therapy Outcomes Registry as a means to evaluate costs associated with outpatient intravenous therapies. In addition, they examine how insurer perspective influences observations regarding resource utilization.
These articles are not intended to suggest that the methods described are without limitations; rather, it is hoped that this supplement will stimulate discussion regarding pharmacoeconomic methods. Furthermore, it is our intent to encourage the development and evaluation of novel approaches for assessing the impact of treatment interventions, thus allowing clinicians to make informed decisions regarding the new therapies, their efficacy and costs to the health care system.
Great strides have been made in the practice of medicine over the past 20 years. We have developed ways to use antibodies to provide targeted delivery of cytotoxic agents. Lasers are used to perform complex surgical procedures with minimal host intrusion. Techniques have been developed that cloak potent but extremely toxic antimicrobials, allowing them to be safely administered to patients. We even have mapped the entire human genomean accomplishment that one day may result in the development of incredibly accurate diagnostic tests and gene therapies. Unfortunately, progress has not come without a price. Over the same time in which we have witnessed this leap in medical knowledge and technology, we also have seen a tremendous increase in the cost of health care. All clinicians want to provide their patients with the best therapies possible. Unfortunately, this often translates into prescribing the newest and most expensive agents available. As a result of this practice, significant economic pressures have been placed on health care systems. The dilemma that we now face is how to use our limited health care resources in the most efficient manner without compromising patient care.
The science of pharmacoeconomics was born out of the need to balance patient care with health care resource management. Various methods have been developed under the umbrella of pharmacoeconomics that allow clinicians and decision makers to systematically assess the safety and efficacy of a drug or procedure and evaluate the impact of utilization on patient-related costs. Acceptance of data generated from pharmacoeconomic studies has suffered somewhat as the result of methodologic disagreement, perspective biases, and perception that pharmaco-economic studies were developed solely for the purpose of marketing. Many of the criticisms stem from the use of estimations for event rates and costs, which introduce a level of subjectivity and thus potential bias into studies. In response to these limitations, investigators began to develop methods that allow for truer assessment of health care resource utilization. Although more labor intensive, data generated tend to reflect a more accurate summary of real-life scenarios rather than cost estimations.
In this supplement, we have attempted to describe and provide examples of relatively novel pharmacoeconomic approaches. In the first article, we introduce the concept of health care utilization as a constantly changing or dynamic parameter. The study of changing patterns of health care utilization over the course of disease management has been referred to as econodynamics. In the next article, Dr. Zhiming Li and colleagues explore the use of length of stay as a marker of treatment efficacy. Factors affecting the length of stay, both treatment related and unrelated, are evaluated, and their impact on variable validity is discussed. Drs. Yehuda Carmeli and Essy Mozaffari discuss the use of insurance claims databases as a method for assessing resource utilization associated with outpatient drug therapy. In the last article, Dr. Alan Tice and colleagues discuss the use of novel databases such as the United States Outpatient Parenteral Antibiotic Therapy Outcomes Registry as a means to evaluate costs associated with outpatient intravenous therapies. In addition, they examine how insurer perspective influences observations regarding resource utilization.
These articles are not intended to suggest that the methods described are without limitations; rather, it is hoped that this supplement will stimulate discussion regarding pharmacoeconomic methods. Furthermore, it is our intent to encourage the development and evaluation of novel approaches for assessing the impact of treatment interventions, thus allowing clinicians to make informed decisions regarding the new therapies, their efficacy and costs to the health care system.