Sobre la necesidad de la farmacoeconomía. Comenzar por los principios

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Abstract

Los gastos en salud y el uso de medicamentos han aumentado de forma importante en los últimos años, lo que alerta a gobiernos y entes sanitarios y puede relacionarse con algunos fenómenos: prescripción médica poco estandarizada, ganancias exageradas de la industria farmacéutica, avances en biotecnología y desperdicio de recursos, falta de comunicación entre gestores públicos y médicos clínicos y ausencia de regulación en precios de fármacos. La importancia de la farmacoeconomía se fundamenta en varios aspectos: optimización de prescripción médica, papel crucial en la comercialización y la distribución de medicamentos, capacidad de mostrar un amplio panorama del impacto social y económico de las enfermedades, como de abrir perspectivas de investigación en varios campos del conocimiento. Dentro de los tipos de estudios farmacoeconómicos se encuentran los que expresan la unidad de ingreso (costos) en términos monetarios y los resultados en unidades monetarias, naturales o de utilidad: reducción de costos (costo minimización), costo beneficio, costo utilidad y costo efectividad, como también los que estudian el panorama global de las enfermedades (análisis costo de la enfermedad). Los costos en salud se distribuyen de la siguiente manera: costos directos (médicos y no médicos), indirectos (impacto en la sociedad como unidad productiva) e intangibles (relacionados con calidad de vida de pacientes y familiares). La farmacoeconomía permite una mejor práctica clínica, sistemas de salud más eficientes y un consumo de recursos más racional. El uso de estos estudios es necesario para estructurar programas de salud y tomar decisiones. Así mismo es recomendada la inclusión de conceptos de economía de la salud en programas de medicina y ciencias de la salud.

Translated abstract

Health expenditures and medication usage have increased dramatically in last years, situation that alerts governments and health authorities, and than can be related with some facts: not standardized medical prescription, excessive gains of the pharmaceutical industry, recent advances in biotechnology related with resource wastefulness, lack of communication between public health entities and clinical physicians and lack of consistent regulatory policies about drug prices. The importance of pharmacoeconomics is based on some aspects: better medical prescription, important role in commercialization and distribution of medicines, capacity of showing a broad and complete scenario of the social and economic impact of diseases, as opening research perspectives in different scientific fields. Within pharmacoeconomical analyses we can found those that show incomes (costs) in monetary units and show outcomes in monetary, natural or utility units: cost minimization, cost benefit, cost utility and cost effectiveness, and also we can found those analyses that study the general panorama of diseases (cost of illness studies). Health costs can be divided into: direct costs (medical and not medical), indirect (economical impact on society) and intangible (related with quality of life of patients and their families). Pharmacoeconomics can lead to a better medical practice, to more efficient health systems and to a more rational usage of resources. These studies are necessary for a proper structure of health programs, as for decision making. The inclusion of health economics concepts within medical and health sciences curricula is also recommended.

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Cost-of-illness analysis. What room in health economics?

Rosanna Tarricone (2006)

Cost-of-illness (COI) was the first economic evaluation technique used in the health field. The principal aim was to measure the economic burden of illness to society. Its usefulness as a decision-making tool has however been questioned since its inception. The main criticism came from welfare economists who rejected COIs because they were not grounded in welfare economics theory. Other attacks related to the use of the human capital approach (HCA) to evaluate morbidity and mortality costs since it was said that the HCA had nothing to do with the value people attach to their lives. Finally, objections were made that COI could not be of any help to decision makers and that other forms of economic evaluation (e.g. cost-effectiveness, cost-benefit analysis) would be much more useful to those taking decisions and ranking priorities. Conversely, it is here suggested that COI can be a good economic tool to inform decision makers if it is considered from another perspective. COI is a descriptive study that can provide information to support the political process as well as the management functions at different levels of the healthcare organisations. To do that, the design of the study must be innovative, capable of measuring the true cost to society; to estimate the main cost components and their incidence over total costs; to envisage the different subjects who bear the costs; to identify the actual clinical management of illness; and to explain cost variability. In order to reach these goals, COI need to be designed as observational bottom-up studies.