Drugs, money and society

Drugs, money and society (Part II)

Pharmacoeconomics started as marketing but has developed into a valuable tool in the fuller assessment of drug therapies. Its principles are now widely accepted, and many countries have government-funded agencies with responsibility for its application, most notably the National Institute for Health and Clinical Excellence in England. Many clinical pharmacologists are active in this area, and the discipline itself is part of the clinical pharmacology trainees' curriculum. Further developments will include value-based pricing and its use in cost sharing arrangements between health service and manufacturers.

Public views on priority setting for high cost medications in public hospitals in Australia

OBJECTIVE

To gather information about views of members of the general public about access to High Cost Medications (HCMs) in public hospitals.

METHODS

A structured questionnaire was administered to members of the general public. Individuals were approached in train stations, shopping centres and different venues in the Sydney metropolitan area. People were eligible to answer the survey if they were: over 18 years of age, Australian permanent residents and able to complete the questionnaire in English.

RESULTS

Two hundred people completed the survey. Of these 56% were females, 47% were married, 84% spoke English at home, 88% were working either full-time or part-time, 61% had a university degree, 27% had a household annual income greater than 100,000 dollars and 68% had private health insurance. Participants considered factors such as treatment outcomes, quality of life and current health status when determining who should have access to HCMs. Participants wanted resources to be allocated to provide the 'greatest benefit to the greatest number of people'. Almost half the respondents did not want direct involvement in decision-making, however, 38% did.

CONCLUSIONS

The results offered support for indirect involvement through the development of a process to involve community members in discussion on policy on the provision of treatment and services within health-care institutions and specifically, to seek the views of members of the public on the provision of HCMs and expensive services within public hospitals.

The value of reporting therapeutic ineffectiveness as an adverse drug reaction

Therapeutic ineffectiveness is a frequent drug-related problem that can occur in a variety of different situations and be caused by different mechanisms. Examples are inappropriate use, interactions or metabolic abnormalities. Observations in patients of unexpected ineffectiveness can provide important information with regard to such situations. Therefore, ineffectiveness--especially when unexpected or unexplained--is a potentially important reportable event in pharmacovigilance. The terms regarding ineffectiveness in the WHO Adverse Reaction Terminology (WHOART) have been recently revised in order to enable optimal coding of such case reports.