23.8 Current and future uses
of pharmacoeconomic
outcomesThe future for pharmacoeconomics is promising in
the current healthcare environment. However, like
any discipline, pharmacoeconomics has its limita-
tions (Jennings and Staggers, 1997):
1.Competing perspectives create tension, for
example pharmacoeconomics versus clinical
importance. Differences in perspective may
be irreconcilable because they relate to a per-
ceived encroachment: ‘turf wars’ can erupt
between clinical, marketing and pharmacoe-
conomics departments within the same com-
pany, in spite of all three professing the same
goal, that is to successfully market a worth-
while drug in a proper fashion.2.Need for rapid response. Protocol in twoweeks
versus six weeks? Sometimes it takes longer to
develop the pharmacoeconomic portion of a
protocol. There may be fewer people to do it,
there are more likely to be unknowns and there
may be a need to decide which instrument to
use; worse yet, there may be no baseline data to
validate any chosen instrument. Studies that
examine efficiency are especially likely to
require more planning.3.Lack of prototype. Some groups want these
studies to be pragmatic and relevant to every-
day practice, yet there is no prototype to
delineate the basic tenets of such studies,
meaning that the data may be riddled with
inaccuracies and misrepresentations. Addi-
tionally, the regulatory agencies may be more
concerned with internal validity than the prag-
matic approach would allow.4.Performance measure pitfalls. What gets mea-
sured reflects system values. If clinical groups
are measured on the ability to meet target-
filing dates, then peak sales potential will be
ignored. Relevant clinical indicators of perfor-
mance may not be known, neither is it the best
combination of data.5.Dearth of patient-centered outcomes measures
in traditional drug development. Physicians
are usually relied upon for clinical data. Data
from the patient are sometimes perceived to be
‘soft’. Patient perspectives may also be missed
when the traditional clinical focus may be
disease- or organ-dominated.6.Discrepancies in terminology. A new lexicon
is emerging. The lexicon must be carefully and
precisely translated in its application to health-
care to avoid miscommunication. Marketing
may ask for a CHA and not know thedifference
between a CHA and a CEA. They may not
understand the approaches, but will only latch
on to the buzzwords.7.When to measure. A major challenge for clin-
ical studies is when to measure. At what point
in the process is the end point reached? The
decision can significantly affect the cost and
time of conducting a study. Unfortunately,
there are no obvious guides, but there should
be sufficient proximity between process and
outcome measures to believe the linkage.8.Value. To what extent is value related to qual-
ity? If there is no standard definition of quality,
quality may be overridden by cost. It is difficult
to quantify nonmonetary value into a neat
formula. The challenge is to propose quality
indicators that allow calculating a balance of
quality and cost.9.Absence of clearly delineated perspective(s).
Outcomes can be categorized in a variety of
ways, including disease, patient, provider and
organizational. There will likely be multiple
perspectives, but it still needs to be orderly.10.Outcomes are not processes. Patient care and
quality dimensions of outcomes must be con-
sidered.This applied discipline of pharmacoeconomics is
slowly evolving. Despite its lack of maturity, many
people and systems are embracing it as a savior.
Although pharmacoeconomics is an important300 CH23 PHARMACOECONOMICS: ECONOMIC AND HUMANISTIC OUTCOMES