Cost-effectiveness analysis gives global view of price

Results expand direct cost analysis

While on rotation as a drug information specialty resident, one pharmacist decided to take a more comprehensive look at how much one drug would cost the health center if it were added to the formulary.

Enoxaparin was the first-line agent being used at the University of Pittsburgh Medical Center as treatment for venous thromboembolism (VTE) prophylaxis in orthopedic hip surgery patients. "We looked at adding fondaparinux as an alternative first-line agent based on efficacy, but we wanted to present the Pharmacy and Therapeutics Committee with a more broad analysis of cost. Looking at the agents on straight acquisition cost only, did not support our recommendation to add the agent as a first-line alternative to enoxaparin," reports Bethany A. Fedutes, PharmD, drug information specialty resident.

She and other researchers decided to implement a model cost-effectiveness analysis (CEA) of the drug, to look at overall cost consequences. "I wouldn’t say that the cost-effectiveness analysis is better than looking at the cost itself, but it is more informative for the overall health system," she says.

Fedutes developed the analysis through a literature search, implementation of a decision tree analysis, and the use of triage data software.

"When looking at any pharmaco-economic analysis, there are steps and procedures of collecting data on event rate, efficacy, and costs." In addition, prior cost-effective analysis may be available in which you can possibly input your data or pull medication costs or direct and indirect medical costs from the primary literature, she says.

Comparing the two analyses

Once the analysis was complete, Fedutes compared the results to enoxaparin use, looking at factors such as average cost and probability of death avoided. The picture was definitely different than looking at straight drug cost, she says. Although fondaparinux is a more expensive agent, the cost/effectiveness (cost/probability of death avoided) incremental difference between the two agents was $149.33.

"When you factor in effect and other indirect or direct medical costs, there was more of a cost neutralization that was seen after the analysis was performed than specifically looking at straight acquisition costs of the agent," Fedutes explains.

The details from the CEA helped shape the formulary decision process. "It gives a more global picture of the effect of the drug on the formulary or on the costs of the health system," Fedutes says. The Pharmacy and Therapeutics Committee made the recommendation to add fondaparinux as a first-line low molecular weight heparin agent for VTE prophylaxis in hip fracture patients.

[Editor’s note: The results of this analysis were presented during the Drug Information Innovations Session at the December clinical meeting of the American Society of Health-System Pharmacists in New Orleans. Other researchers involved in the project were Nicole T. Ansani, PharmD, associate director of the Drug Information Center at the University of Pittsburgh School of Pharmacy; and Susan J. Skledar, RPh, MPH, director of Drug Use & Disease State Management at the University of Pittsburgh Medical Center.]