1. Session 3 - Workshop Brian Godman and Dr Alan Haycox Health Economics Unit University of Liverpool Management School Onco-Pharmacoeconomy Training Course Turkey ISPOR Training Course

2. As previously discussed on resource Valuation Average costs Marginal costs Opportunity costs A value is attached to each resource consumed Resources can be valued differently… Health economists and policy makers emphasise the importance of ‘opportunity costs’ in valuing overall expenditure as budgets are finite

3. As discussed, the most important concept in health economics is Opportunity Cost The opportunity cost of using resources to produce a good or service is the benefits foregone from those resources not being used in their next best alternative. The concept of opportunity cost lies at the heart of all economic analyse The health policy goal is to maximise patient outcomes with available resources. This means some benefits will be foregone – but these should be minimised

4. Case History – Adjuvant HERCEPTIN in Breast Cancer in one UK Hospital Currently 355 patients receive adjuvant treatment in Norfolk and Norwich at GB£0.503mn/ year (16 cured at a cost/ cure ranging from £23000 - £137,000) Treating 75 patients with early stage breast cancer with HERCEPTIN would cost GB£1.94mn/ year rising to GB£2.3mn with testing, monitoring and administration at a cost/ cure of £650,000 Finite budgets mean tough decisions need to be made on which treatments should be funded and which should be terminated or reduced Ref: Barrett et al BMJ 2006

5. Costs and potential benefits of adjuvant cancer treatments in Norfolk Hospital Treatment and number of patientsDrug cost (GB£000) Cost/cured patient (GB£000) Adjuvant chemotherapy for lung cancer (15 patients) 23 Oxaliplatin as adjuvant therapy for colon cancer compared with fluorouracil alone (20 patients) 137 Neoadjuvant chemotherapy for oesophageal cancer (25 patients) 82.67 Rituximab in addition to CHOP for non-hodgkin lymphoma in patients over 60 (25) 21571.67 Adjuvant aromatase inhibitors in postmenopausal breast cancer (270 patients) [NB drug costs will fall substantially in Europe once generics routinely available] 12015 Total – 355 patients and 16 cured503 Ref: Barrett et al BMJ 2006

6. Workshop questions – based on the paper by Barrett et al in the BMJ in 2006 Should HERCEPTIN be funded for use in adjuvant breast cancer patients in oncology units in Turkey? If yes, and there are no additional funds, what patients should receive HERCEPTIN and how will this be paid for, i.e. what other treatment approaches will be reduced? This could be other technologies including drugs as well as personnel

7. Workshop logistics Break into small groups Elect a spokesperson to feed back Feedback starts at 17.00