Study On Demands, Evaluation Methods And Guidelines Of Pharmacoeconomics

Background Pharmacoeconomic evaluation is based on the classic welfare economics theoryand developed into an evaluation technology which identifies, measures and comparesthe cost and effectiveness of different drugs, treatments and health services to improveboth the allocation and efficiency of medical resource utilization. It has been regardedas the fourth hurdle of evaluations coordinated with quality, safety and efficiency inthe world. Pharmacoeconomic evaluation has constructed a systematic framework ofevaluation for 30 years. Faced with the pressure of medical costs control and reformsof health system, more and more countries begin to apply pharmacoeconomicsevaluation into drug pricing, formulary decision, clinical guidelines, diseases controland new drugs' R&D. In regard to existing controversy in evaluation methods anddiscrepancy in the health system of different countries, more than twenty countriessuch as Australia, Canada, US, France and Netherlands have issued the evaluationguidelines of pharmacoeconomics evaluation successively.In China, the share of high proportion of drug costs on total health expenditures andunmatched growth rate with GDP are generally key issues. Since 1998, the nationalgovernment has put a package of drug regulation polices for the purpose ofcontrolling drug costs in the drug circle from manufacturing, distribution topurchasing which is closely related with the current tripartite system reform, but itemphasized particular on regulation of drug production and distribution and ignoredthe rational use of drug, especially the control of prescription from the provider side.on the other hand, the pharmacoeconomic research started behindhand and theevaluation is confined to the academia and the pharmaceutical companies formarketing sales. It is urgent and necessary to choose the appropriate evaluationtechnologies and apply them into comprehensive containment of drug costs in order tocatch up with the other countries in view of international experience and cope withdomestic circumstance. 5复旦大学博士学位论文 药物经济学评价需求,方法与指南研究ObjectivesWe put forth a methodological principles for pharmaoceconomics evaluation in orderto provide the bases for clinical prescription, drug pricing and reimbursement, newdrugs licensing and research standardizing by analyzing the demand and supply ofpharmacoeconomic evaluation, using experience and theories of internationalguidelines, exploring the new methods in health evaluation such as measurement ofhealth utility, uncertainty analysis, net-benefit method, decision analytical modelingand budget impact analysis. The detailed purposes are as follows:1. To make clear the demands and obstacles for applying pharmacoeconomics evaluation in Chinese health care system;2. To evaluate the status quo, quality and existing problems in the publications of pharmacoeconomics evaluation in China;3. To explore the application of new evaluation methods such as measurement of health utility, uncertainty analysis, net-benefit method, decision analytical modeling and budget impact analysis;4. To draft a methodological principles for pharmaoceoconomics analysis suited to national setting;5. To discuss the necessity, feasibility and application of the pharmacoeconomic evaluations.MethodsBy means of welfare economics, health economics, econometrics, decision theory andhealth statistics we explored the demand and supply, new methods and guidelines inpharmacoeconomics evaluation. Descriptive analysis, factor analysis and chi-squaretest were used to assess the demand and obstacles for applying pharmacoeconomicsevaluation in Chinese health care system. The ANOVA analysis, non-parametricKruskall-Wallis method and multiple comparisons were used to evaluate the quality ofthe published pharmacoeconomics studies. Systematic review and panel consulta...