1. 195219902003 Pharmaceutical Economics Heng-Sim Lee RPh MS Director of Pharmacy, ChiaYi Branch, Taichung Veterans General Hospital Clinical Nutritional Pharmacist Council Member of Taiwan Society of Parenteral and Enteral Nutrition (TSPEN) Professional Representative of Parenteral and Enteral Nutrition Society of Asia (PENSA) Council Member of Chia Yi city Pharmacist Association Lecturer of Nursing Institute, Hung Kuang University 30 th Nov. 2013

2. Pharmaceutical Care 30 th Nov. 2013

3. The Pharmacist becomes more The Pharmacist becomes more specialised as a therapeutic advisor The Pharmacist becomes more The Pharmacist becomes more specialised as a therapeutic advisor Hospital Pharmacists move closer to Patient Care What is Pharmaceutical Care? Changes in Pharmacy Practice 30 th Nov. 2013

4. Pharmaceutical Care Need Goal Process Outcome Quality Assurance of Drug Therapy Quality Assurance of Drug Therapy 30 th Nov. 2013

5. Pharmaceutical care ‘’Pharmaceutical care is the direct, responsible provision of medication-related care for the purpose of achieving definite outcomes that improve a patient’s quality of life.’’ Cure of the diseaseCure of the disease Elimination or reductionElimination or reduction of symptoms of symptoms Arrest or slowing of aArrest or slowing of a disease process disease process Prevention of diseasePrevention of disease or symptoms or symptoms Hepler CD and Strand LM (1990) 30 th Nov. 2013

6. Clinical Pharmacist integrates into medical specialties Variety of models Innovations inPharmacy Services Innovations in Pharmacy Services Clinical Pharmacist serves 60 beds Emergence of the Teacher- Practitioner Pharmacist as ward visitor serves 120 beds beds 1970s1980s 1990s2000s Community Pharmacy Patient Medication Records Pharmacy Patient Computer Records and Services to Elderly Nursing Elderly Nursing Homes Homes Primary Care Pharmacy Pharmacy Targeted Services 30 th Nov. 2013

7. Verifying VerifyingTreatment Treatment MonitoringTreatmentMonitoringTreatment Confirming Outcomes of Treatment Confirming Outcomes of Treatment Transferring care Clinical Management Plan 30 th Nov. 2013

8. Profile of Patient’s Characteristics Patient Comprehension/Participation Confirmation of Need Drug History Contra-indications/Interactions Treatment Plan Conformity to Guidelines Achievement of Treatment Goals Confirmation of Safety Individualised Dose, Dose Frequency, Means of Administration Adherence to Treatment Clinical Monitoring Laboratory Markers Verification Confirmation of outcomes Monitoring Unwanted Symptoms Recorded Adverse Reaction 30 th Nov. 2013

9. Patient Profile Laboratory tests Medication Pharmaceutical care plan DocumentationDocumentation ResponsibilityResponsibility 30 th Nov. 2013

10. History 1940~1960 Era of Expansion period 1970~1980 Era of Cost containment 1990~ Era of Assessment and Accountability for Health Outcome 30 th Nov. 2013

11. Definition of Pharmacoeconomics The process of identifying, measuring, and comparing the costs, risks, and benefits of programs, services, or therapies To determine which alternative produces the best health outcome for the resource invested Most impactful when making decisions about a population rather than individual “Costs vs. Consequences of Alternatives” 30 th Nov. 2013

12. Micro to Macro Applications with Pharmacoecomomics Education in safe and effective prescribing practices. AAMC. July 2008. From Board Room to Bedside 30 th Nov. 2013

13. Perspective of Pharmacoeconomics Patient perspective Provider perspective Payer perspective Societal perspective 1.Direct medical costs 2.Direct non medical costs 3.Indirect nonmedical costs 4.Intangible costs 5.Opportunity costs 6.Incremental costs After selection of perspective next step cost related measurements 30 th Nov. 2013

14. Application of Pharmacoeconomics Clinical Pharmacy Service Evaluation Determining the value of an existing services Estimating the potential worth of implementing a new service Capturing the value of a “cognitive” clinical intervention Industry-marketing pricing, performance guarantee Managed care – protocols, guidelines, formularies Physicians – individual patient treatment decisions, prescribing, payer-performance Consumer – education, autonomy Government – pricing, approval, formularies, policy Institution – protocol, guidelines, formularies Pharmacist – formularies, protocol, guideline, pharmaceutical care service or program evaluation Drug Therapy Evaluation – Selective the most cost-effective drugs for an organizational formulary Making a decision about an individual patient’s therapy Customizing a patient’s pharmacotherapy 30 th Nov. 2013