CURRENT ISSU ES

6. Discounting: Discounting is necessary to compare treatments with costs and outcOmes that occur at different times. The discount rate, which must be applied to both inputs and outputs. illustrates the opportunity cost of a treatment over a particular time horizon. 7. Incremental analysis: Incremental analysis should be used to quantify the additional costs of receiving a funher unit of output. For example. this type of anaJysis is needed to compare the efficiency of a costly drug that is very effective with one that is less costly and less effective. 8. Sensitivity ana1ysis: Sensitivity analysis is performed to check the validity of the assumptions

used in a pharmacoeconornic analysis. An ' analysis of extremes' should be performed; Le. varying aU uncertain variables at the same time and considering only the most positive and negative outcomes.

Qarattirti L. Orilli R. Scopclliri D. M&rII(W;IDi L A ~ f,.llalian ",ideline:s in pharmail:oeconomics. Pharmac:oEconomics 7: 1-6. J.., 1m -,. EdiJoriaJ comment: In a plYvious issue, Professor Michoel Drummond/rom 1M University of York, UK. discussed the obj~ctiv~s 0/ guiddin~s lor plwnnacoeconomic snuii~s and lhe parties with a Slake in such guiddines (su PlwnnacoR~sourr:~s 19: 6, 17 D« 1994J.

International Research and Opinion

The prescribing of antiasthmatics and their associated costs

Good medical practice and cost consciousness do not necessarily go hand in hand, according to UK-based investigators. Pressure to reduce the cost of antiasthmatic drugs may result in a decrease in the prophylactic:bronchodilator prescribing ratio, and this is not a cost-effective option, they say.

The investigators examined the patterns and cOsts of preventive, compared with reactive, prescribing among patients with asthma in the City and East London Family Health Services Authority. The analysis, which involved 163 general practices, used general practitioners' (GP) Prescribing Analysis and CosT (PACf) data.

The unit COst of antiasthmati c prescribing was significantly higher among practices with a GP trainer. with band 3 health promotion and those with asthma surveillance. The item ratios for prophylacticlbronchodilalor prescribing were significantly higher among these practices. while those with band 3 health promotion and asthma training were also associated with higher prophylaclic:bronchodilator cost ratios .

Furthermore, a higher unit cost of antiasthmatics was seen among practices that prescribed a higher level of overall generic drugs and generic asthma drugs. There was al so a pos itive correlation between the level of generic prescribing and the prophylactic :bronchodilator ratios for both items and costs.

'Clearly, generic prescribing is not a valid measure of good quality prescribing', comment the investi gators.

Thus, there appears to be a need fo r a more sophisticated strategy to enhance the quality of prescribing, taking into consideration the numerous determinants o f presc ribing decision s in general practice, conclude the investigators.

Naish 1. Suudy P. TOOl! P ...... ppropriaIe ~bini in uthma and its rel.aled COSt in east I...oodon. BritUb Medical Journal 310: 97· 100. 14 Jan 1995 --l ln~l.o:m.sol .orJ> Ad'- -...tlonlol UmINod ltH. All rlghUo r--...d

Cost considerations ...

• Delaying therapy with granulocyte colony­stimulating ractor (G-CSF) can reduce treatment costs in patients who have undergone bone marrow transplantation (BMn for malignant lymphoma, say researchers in France. - 49 patients received a 3O-minute IV infusion of recombinant G-CSF [filgrastim] 5 Ilglkglday either I day or 6 days after BMT. Delaying G-CSF therapy for 6 days reduced total treatment by a median of 7 days. compared with administration on day 1. Total G-CSF acquisition costs for the 2 treat­ment groups were SUS 1120 and S1980, respectively. There was no difference in time to haematological recovery. infectious complications o r duration of hospitalisation between patients receiving G -CSF on day 1 and day 6. conclude the researchers.

- See Ru earch and Opinion, this issue; p8

Vey N, n al. Debyed ~ of pnuloc:)1e c:oIony-stimulatiq f.:tOr aIier . /,lIoklgOUS bon!: marrow 1ran$pIanWion: dl"en on pnuioc:y1e recovery. Bone Marro ... Trusplanwion 14: n9-782. Nov 1994

- ,

• Interventions targeting specinc pa tients with systemk lupus erythematosus may improve outcomes and reduce the costs of illness. say researchers in Canada and the US. In their study, which involved 151 patients, regression analysis was used to identify those who incurred high and low treatment costs. Patients with poor physical and psychological functioning incurred the highest average direct treatment costs: SUS20 9621patientlyear and SUS II 4661patientl year, respectively, compared with a mean annual direct cost of SUS7304/patient for the entire group. Patients with poor psychological functioning incurred the greatest average indirect costs: SUS J 5 7441patientlyear vs SUS72621patientlyear for the entire group. Also, patients with severe pain experienced the greatest annual loss in work productivity: a mean of 136 days/ patient vs 44 days/patient for the entire group.

a.kc AE. et al.. Decrusiq OOIU aDd improvina: OUICOmCS in J)'SICmic: lupus crythc::mMosus: usin& rq;reWon IlCeI to de¥c:1op beaIth poIio;y. Journal of RheunwolOSy 21 : 2246-225) . o.x 1994

PHARMACORESOURCES 21 oMn 11M

7