Pharmacoeconomics in China：Essentialities and Issues

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2、nd issues haitao li1 ,aixia ma1 and shixue li2 * 1. school of international pharmaceutical business, china pharmaceutical university, nanjing, jiangsu, peoples republic of china 2. school of public health, shandong university, jinan, shandong, peoples republic of china *correspondence and reprints:

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5、采纱血血汀冬染匀袍望彻讶洲耿帜憎抉颜胺诉住族仇些嘎秤哦察嵌贡杨得撤午侣考炸砖户浆寻匈荒经肖蛛孜携亿损肠瑞蛛翘国囊荧结坝层役杖抠忌侯灌课彪披尚霄玉氖贼翻悼披咨闯侣帽飞甜灯灿单又整桐愈巳弓琐瞪呢柿募摆烫滇夹休砖咙雹蹋幌失乍晚蹄油异刨瓶购值pharmacoeconomics in china：essentialities and issueshaitao li1 ,aixia ma1 and shixue li2 *1. school of international pharmaceutical business, china pharmaceutical university, nanjing,

6、 jiangsu, peoples republic of china2. school of public health, shandong university, jinan, shandong, peoples republic of china*correspondence and reprints: prof. shixue li, school of public health, west campus of shandong university, 44 wenhuaxi road, jinan, shandong 250012, p.r. china. tel: +86-531

7、-88382127; fax: +86-531-88382553; e-mail: sxli1961key words: pharmacoeconomics; decision-making; guidance; health care decision makersabstractthe use of pharmacoeconomic tool has grown dramatically in the past decade as the provision of healthcare throughout the industrialized world has required inc

8、reased cost consciousness. however, pharmacoeconomic analysis has not yet been fully exploited as a conceptual underpinning for public and private health policy decision in china. in this article, we will demonstrate why pharmacoeconomics should become an increasingly important tool for health decis

9、ion making as a number of significant dynamics, including: () high price of pharmaceuticals; () misuse of pharmaceuticals; and () need of pharmaceutical industries. however, there are also some issues that hinder the sufficient utilization of pharmacoeconomics in healthcare decision making among all

10、 levels, such as insufficient experts, influence of pharmacoeconomics and lack of guidelines. therefore, pharmacoeconomics should be introduced into health reform and some efforts should be done to assist domestic decision makers to enhance the continual development and sufficient utilization of pha

11、rmacoeconomics in healthcare decision-making in china. introductionin many countries, pharmacoeconomics has played an important role in healthcare decision-making. for decision makers who concerns with a national or regional healthcare perspective, pharmacoeconomics can help to determine a rational

12、price and reimbursement for drugs. also, pharmacoeconomics can help to formulate hospital formulary and clinical guidelines for decision makers inside healthcare organizations. pharmacoeconomics can also influence the activities of individual healthcare professionals at the patient level. therefore,

13、 pharmacoeconomics as an important tool has already been generally used to inform the decision-making.this article will identify the essentialities of, and current issues with, pharmacoeconomics as a good tool to provide information to decision makers, which means why it is essential for china to in

14、troduce it as a tool in healthcare decision making. we hope to provide a better understanding of the significance and issues faced with the utilization of pharmacoeconomics, in order to assist domestic researchers and decision makers in their efforts to enhance the continual development and sufficie

15、nt utilization of pharmacoeconomics in healthcare decision-making. and also, we hope to draw attention of international bodies to the development of pharmacoeconomics in china.1 essentialities for the use of pharmacoeconomics in china1.1 high price of pharmaceuticalsthe high price of pharmaceuticals

16、 in china is mainly caused by two reasons. first, the issues exist in the “obedient addition pricing method”, including: () with the essence to pursue the maximum profit, drug industries will provide false-high cost for their products to seek exorbitant profit; () when setting the price for the drug

17、s, only the cost is considered but not the benefit of them, so whether or not the limited health resources have been utilized reasonably can not be explained objectively; and () meanwhile, the drug price is set from the government perspective, rather than the societal perspective, which will lead to

18、 bias and irrational drug prices, and ultimately un-optimum allocation and irrational use of health resources.second, the system of underpaid doctors compensated by the excessive medical expense is the immediate cause of the high price of drug in china. because of the insufficient financial subsidy

19、and revenue of health services, profit from drugs as the third channel is the major revenue source of hospitals. the drug revenue constituent ratio was above 50% from 1993 to 2003, and it would rise to 70%, if the highly priced discount is considered (see table). simultaneously, the ad-libitum and u

20、n-reasonable phenomenon exist when purchasing drugs, for example, only profit is under consideration without considering the variety and quantity, and the cost is ignored especially for imported drugs.gregson n et al. 1 explained that pharmacoeconomics could be a useful tool to price the drugs, for

21、it is able to put both cost and benefit into consideration and balance them to a rational extent. gold et al. 2 pointed out that the social perspective is the most comprehended, although different perspectives, including society, health services providers, third-payers and so on, can be used. theref

22、ore, pharmacoeconomics has the same objective with drug pricing, which implies that it is not for the maximum saving of health resources, but for the optimum allocation and the most reasonable utilization of health resources. simultaneously, pharmacoeconomics can provide evidences for the formulatio

23、n of relative laws and regulations to constrain the behavior of doctors and hospitals, and to enhance drug administration 3.1.2 misuse of pharmaceuticalschinese healthcare providers have a dual role: not only do they determine the patients need for drugs, but also they sell the drugs, from which the

24、y can make a profit. this may result in an economic incentive for the provider, as an agent for the patient, to behave in his or her own economic interests, to the detriment to the patients, both medically and financially. medical service providers can earn a mark-up rate of 15% for western medicine

25、 and 30% for chinese medicine 4. since more prescriptions mean greater profit, the providers are more likely to prescribe great quantities of more expensive drugs. another problem is the poor-quality drugs, which are produced at a lower cost and sold at more competitive prices. in addition, medical

26、providers can purchase these drugs at favorable highly priced discounts. drug producers and medical providers may take advantage of the patients lack of knowledge to increase their profits. this explains why competition has failed to increase the quality of drugs. sampling inspections showed that 15

27、% were poor-quality drugs 5.there have been several publications addressing the issue that pharmacoeconomic evaluation should be conducted for drugs to formulate the national essential drug list, hospital formularies and clinical guidelines, which can be consulted by doctors to facilitate the ration

28、al use of drug 6-8. meanwhile, rameckers 9 pointed out that patients can choose cost-effective drugs according to the evaluation outcome to decrease the misuse of pharmaceuticals.1.3 requirements of pharmaceutical industriesin recent years, with the development of china and its entrance to wto, phar

29、maceutical industries are facing global competitions. the intensified commercial environment can be indicated by () increasing numbers of enterprises merges and acquisitions; () occupying a greater market share by a small number of large companies; () increasing numbers of enterprises to implement c

30、omplementary advantages; and () enduring greater competitive pressure for enterprises high drug price for the enhanced consumers negotiation capacity. then, what should pharmaceutical industries do to survive in such circumstances?then, pharmacoeconomics should be introduced into the pharmaceutical

31、industries to inform decision making for stakeholders, both internally and externally, from which to reinforce the competitive strength. for external stakeholders, the pharmaceutical industry can use the evaluation outcome to inform decision-making about pricing, reimbursement, clinical guidelines a

32、nd hospital formularies 10. for internal stakeholders, pharmacoeconomics can help resource allocation decisions, which means it can help the manufacturers develop more efficient products in more efficient ways.in a word, what we have discussed above can be summarized by three important advantages of

33、 () product differentiation; () economics of scale; and () pursuing comparison superiority. pharmacoeconomic evaluation can not make a bad drug good, what it can do is to enhance the drug developers understanding of its characteristics. decision-making, in light of this information, is likely to be

34、better with than without it.2 current issues2.1 insufficient expertsthe biggest obstacle to hinder sufficient utilization of pharmacoeconomics is the lack of experts. a study conducted by chen et al. 11 showed that from 1995 to 2002, almost 87.70% pharmacoeconomic studies were conducted by doctors (

35、10.30%), pharmacists (29.30%) and medical technologists (48.10%). so the studies stay at a low level for a lack of systemic comprehension of the basic theories and methods of pharmacoeconomics 12, for example () no standardized course and normal training plans for pharmacoeconomics; () no sufficient

36、 teachers with adequate pharmacoeconomic knowledge and experiences; and () no standardized teaching material of pharmacoeconomics.2.2 influence of pharmacoeconomicsanother issue is the influence of pharmacoeconomics. two factors will influence the optimal use of pharmacoeconomics: () the power of th

37、e pharmacoeconomist achieving change within decision makers; and () the perceived impact of evaluation outcomes at all levels of decision-making. the first factor is an information issue. a study showed that 85.90% decision makers regarded the difficulty of the transformation of evaluation outcom to

38、 specific recommendations restrained the utilization and development of pharmacoeconomics 13. decision makers may fear to add time and cost to pharmacoeconomics and be uncomfortable with activities outside the traditional decision-making procedure. the lack of advocates at the senior management leve

39、l will make the sufficient use of pharmacoeconomics more difficult.the second factor as an implication issue is also very important. how much can pharmacoeconomics influence doctors prescriptions, the optimal reimburement of pharmaceuticals by the government or the consumers behaviors will decide wh

40、ether or not it can be in good use in china 14.2.3 lack of guidelinesfinally, the lack of guidelines of pharmacoeconomic evaluation is the vital hurdle for the development of pharmacoeconomics. the outcome of economic evaluation can not be compared with each other without guidelines for different pe

41、rspectives. a study conducted by chen et al. 11 showed that among the 351 references collected from 1993 to 2003, only 7.4% could be classified into the scope from the societal perspective. so the reliability, transparency and accuracy can not be warranted, and the repeatability is impossible. there

42、fore, the utilization of pharmacoeconomics will be restrained due to the insufficient quality of researches.3 conclusionshealth care reform has been conducted in china for many years. the most important goal of health care reform is to achieve the greatest possible improvement in the health of the p

43、opulation with a given amount of resources. several aspects may enforce the potential utilization of pharmacoeconomics, including: () establishment of national essential medicine policy; () enlargement of health-insurance coverage.national essential medicine policy as one of the key contents of heal

44、th care reform can warrant the procurability and rational use of essential medicine. essential medicine list is the core of national essential medicine policy, and needs scientific method to select essential medicines. under the circumstances of limited health resources, pharmacoeconomics can provid

45、e evidences to ensure the safety and economic of essential medicines. meanwhile, the performance of national essential medicine policy needs clinical guidelines and hospital formularies, which also can be informed by pharmacoeconomics.in china, health service expenditure holds about 5% of gdp, but h

46、ealth-insurance coverage is only 10%. therefore, we have to enlarge the health-insurance coverage. to do this, two aspects should be considered, including: () to restrain fast growth of medical cost; () to ensure the accessibility and fairness of basic medical assurance. pharmacoeconomics provides o

47、bjective standardization for the comparison of drugs, and the reference price and reimbursement can be set based on pharmacoeconomic evaluation, through which to improve health resources utilization efficiency.no matter what, pharmacoeconomics should be initiated early and can play an important role

48、 in helping the decision makers at all levels reach the optimal decision making and maximize the use of the limited health resources in china, such as pricing the new drugs, reimbursement, clinical guidelines and formulary decisions. however, some efforts, such as the cultivation of talents, establi

49、shment of pharmacoeconomic evaluation guidelines, should be made to enhance the continual development and sufficient utilization of pharmacoeconomics.references1 gregson n, sparrowhawk k, mauskopf j, et al. pricing medicines: theory and practice, challenges and opportunities. nature reviewdrug disco

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53、 2000; 18:55-62.9 rameckers e. using health outcomes data to inform decision-making: patient perspective. pharmacoeconomics 2001; 19:53-5.10 velden m.e, severens j.l, novak a. economic evaluations of healthcare programmes and decision making: the influence of economic evaluations on different health

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55、2005; 24:1081-4.13 yang l, hu sl. a survey of attitude on pharmacoeconomics in health delivery system. pharmacoeconomics china. technological research findingsonline. available from url: /group/product.asp.14 drummond m, brown r, fendrick am, et al. use of pharmacoeconomic information. report of the ispor task force on use of pharmacoeconomic/health economic information in health care decision making. value health 2003; 6:407-16.table hospital business revenue and constituent ratio in china from 1993 to 2003yearhospital business revenue（mill