Pharmacoeconomics in ChinaEssentialities and Issues.docx

Pharmacoeconomics in ChinaEssentialities and Issues.docx

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PharmacoeconomicsinChinaEssentialitiesandIssues

PharmacoeconomicsinChina：

EssentialitiesandIssues

HaitaoLi[1],AixiaMa[1]andShixueLi[2]*

1.SchoolofInternationalPharmaceuticalBusiness,ChinaPharmaceuticalUniversity,Nanjing,Jiangsu,People’sRepublicofChina

2.SchoolofPublicHealth,ShandongUniversity,Ji’nan,Shandong,People’sRepublicofChina

*Correspondenceandreprints:

Prof.ShixueLi,SchoolofPublicHealth,WestCampusofShandongUniversity,44WenhuaxiRoad,Ji’nan,Shandong250012,P.R.China.Tel:

+86-531-88382127;Fax:

+86-531-88382553;E-mail:

sxli1961@

KeyWords:

pharmacoeconomics;decision-making;guidance;healthcaredecisionmakers

ABSTRACT

Theuseofpharmacoeconomictoolhasgrowndramaticallyinthepastdecadeastheprovisionofhealthcarethroughouttheindustrializedworldhasrequiredincreasedcostconsciousness.However,pharmacoeconomicanalysishasnotyetbeenfullyexploitedasaconceptualunderpinningforpublicandprivatehealthpolicydecisioninChina.Inthisarticle,wewilldemonstratewhypharmacoeconomicsshouldbecomeanincreasinglyimportanttoolforhealthdecisionmakingasanumberofsignificantdynamics,including:

（ⅰ）highpriceofpharmaceuticals;（ⅱ）misuseofpharmaceuticals;and（ⅲ）needofpharmaceuticalindustries.However,therearealsosomeissuesthathinderthesufficientutilizationofpharmacoeconomicsinhealthcaredecisionmakingamongalllevels,suchasinsufficientexperts,influenceofpharmacoeconomicsandlackofguidelines.Therefore,pharmacoeconomicsshouldbeintroducedintohealthreformandsomeeffortsshouldbedonetoassistdomesticdecisionmakerstoenhancethecontinualdevelopmentandsufficientutilizationofpharmacoeconomicsinhealthcaredecision-makinginChina.

Introduction

Inmanycountries,pharmacoeconomicshasplayedanimportantroleinhealthcaredecision-making.Fordecisionmakerswhoconcernswithanationalorregionalhealthcareperspective,pharmacoeconomicscanhelptodeterminearationalpriceandreimbursementfordrugs.Also,pharmacoeconomicscanhelptoformulatehospitalformularyandclinicalguidelinesfordecisionmakersinsidehealthcareorganizations.Pharmacoeconomicscanalsoinfluencetheactivitiesofindividualhealthcareprofessionalsatthepatientlevel.Therefore,pharmacoeconomicsasanimportanttoolhasalreadybeengenerallyusedtoinformthedecision-making.

Thisarticlewillidentifytheessentialitiesof,andcurrentissueswith,pharmacoeconomicsasagoodtooltoprovideinformationtodecisionmakers,whichmeanswhyitisessentialforChinatointroduceitasatoolinhealthcaredecisionmaking.Wehopetoprovideabetterunderstandingofthesignificanceandissuesfacedwiththeutilizationofpharmacoeconomics,inordertoassistdomesticresearchersanddecisionmakersintheireffortstoenhancethecontinualdevelopmentandsufficientutilizationofpharmacoeconomicsinhealthcaredecision-making.Andalso,wehopetodrawattentionofinternationalbodiestothedevelopmentofpharmacoeconomicsinChina.

1EssentialitiesfortheUseofPharmacoeconomicsinChina

1.1HighPriceofPharmaceuticals

ThehighpriceofpharmaceuticalsinChinaismainlycausedbytworeasons.First,theissuesexistinthe“obedientadditionpricingmethod”,including:

（ⅰ）withtheessencetopursuethemaximumprofit,drugindustrieswillprovidefalse-highcostfortheirproductstoseekexorbitantprofit;（ⅱ）whensettingthepriceforthedrugs,onlythecostisconsideredbutnotthebenefitofthem,sowhetherornotthelimitedhealthresourceshavebeenutilizedreasonablycannotbeexplainedobjectively;and（ⅲ）meanwhile,thedrugpriceissetfromthegovernmentperspective,ratherthanthesocietalperspective,whichwillleadtobiasandirrationaldrugprices,andultimatelyun-optimumallocationandirrationaluseofhealthresources.

Second,thesystemofunderpaiddoctorscompensatedbytheexcessivemedicalexpenseistheimmediatecauseofthehighpriceofdruginChina.Becauseoftheinsufficientfinancialsubsidyandrevenueofhealthservices,profitfromdrugsasthethirdchannelisthemajorrevenuesourceofhospitals.Thedrugrevenueconstituentratiowasabove50%from1993to2003,anditwouldriseto70%,ifthehighlypriceddiscountisconsidered（SeetableⅠ）.Simultaneously,thead-libitumandun-reasonablephenomenonexistwhenpurchasingdrugs,forexample,onlyprofitisunderconsiderationwithoutconsideringthevarietyandquantity,andthecostisignoredespeciallyforimporteddrugs.

GregsonNetal.[1]explainedthatpharmacoeconomicscouldbeausefultooltopricethedrugs,foritisabletoputbothcostandbenefitintoconsiderationandbalancethemtoarationalextent.Goldetal.[2]pointedoutthatthesocialperspectiveisthemostcomprehended,althoughdifferentperspectives,includingsociety,healthservicesproviders,third-payersandsoon,canbeused.Therefore,pharmacoeconomicshasthesameobjectivewithdrugpricing,whichimpliesthatitisnotforthemaximumsavingofhealthresources,butfortheoptimumallocationandthemostreasonableutilizationofhealthresources.Simultaneously,pharmacoeconomicscanprovideevidencesfortheformulationofrelativelawsandregulationstoconstrainthebehaviorofdoctorsandhospitals,andtoenhancedrugadministration[3].

1.2MisuseofPharmaceuticals

Chinesehealthcareprovidershaveadualrole:

notonlydotheydeterminethepatient’sneedfordrugs,butalsotheysellthedrugs,fromwhichtheycanmakeaprofit.Thismayresultinaneconomicincentivefortheprovider,asanagentforthepatient,tobehaveinhisorherowneconomicinterests,tothedetrimenttothepatients,bothmedicallyandfinancially.Medicalserviceproviderscanearnamark-uprateof15%forWesternmedicineand30%forChinesemedicine[4].Sincemoreprescriptionsmeangreaterprofit,theprovidersaremorelikelytoprescribegreatquantitiesofmoreexpensivedrugs.

Anotherproblemisthepoor-qualitydrugs,whichareproducedatalowercostandsoldatmorecompetitiveprices.Inaddition,medicalproviderscanpurchasethesedrugsatfavorablehighlypriceddiscounts.Drugproducersandmedicalprovidersmaytakeadvantageofthepatients’lackofknowledgetoincreasetheirprofits.Thisexplainswhycompetitionhasfailedtoincreasethequalityofdrugs.Samplinginspectionsshowedthat15%werepoor-qualitydrugs[5].

Therehavebeenseveralpublicationsaddressingtheissuethatpharmacoeconomicevaluationshouldbeconductedfordrugstoformulatethenationalessentialdruglist,hospitalformulariesandclinicalguidelines,whichcanbeconsultedbydoctorstofacilitatetherationaluseofdrug[6-8].Meanwhile,Rameckers[9]pointedoutthatpatientscanchoosecost-effectivedrugsaccordingtotheevaluationoutcometodecreasethemisuseofpharmaceuticals.

1.3RequirementsofPharmaceuticalIndustries

Inrecentyears,withthedevelopmentofChinaanditsentrancetoWTO,pharmaceuticalindustriesarefacingglobalcompetitions.Theintensifiedcommercialenvironmentcanbeindicatedby（ⅰ）increasingnumbersofenterprisesmergesandacquisitions;（ⅱ）occupyingagreatermarketsharebyasmallnumberoflargecompanies;（ⅲ）increasingnumbersofenterprisestoimplementcomplementaryadvantages;and（ⅳ）enduringgreatercompetitivepressureforenterprises’highdrugpricefortheenhancedconsumers’negotiationcapacity.Then,whatshouldpharmaceuticalindustriesdotosurviveinsuchcircumstances?

Then,pharmacoeconomicsshouldbeintroducedintothepharmaceuticalindustriestoinformdecisionmakingforstakeholders,bothinternallyandexternally,fromwhichtoreinforcethecompetitivestrength.Forexternalstakeholders,thepharmaceuticalindustrycanusetheevaluationoutcometoinformdecision-makingaboutpricing,reimbursement,clinicalguidelinesandhospitalformularies[10].Forinternalstakeholders,pharmacoeconomicscanhelpresourceallocationdecisions,whichmeansitcanhelpthemanufacturersdevelopmoreefficientproductsinmoreefficientways.

Inaword,whatwehavediscussedabovecanbesummarizedbythreeimportantadvantagesof（ⅰ）productdifferentiation;（ⅱ）economicsofscale;and（ⅲ）pursuingcomparisonsuperiority.pharmacoeconomicevaluationcannotmakeabaddruggood,whatitcandoistoenhancethedrugdevelopers’understandingofitscharacteristics.Decision-making,inlightofthisinformation,islikelytobebetterwiththanwithoutit.

2CurrentIssues

2.1InsufficientExperts

Thebiggestobstacletohindersufficientutilizationofpharmacoeconomicsisthelackofexperts.AstudyconductedbyChenetal.[11]showedthatfrom1995to2002,almost87.70%pharmacoeconomicstudieswereconductedbydoctors（10.30%）,pharmacists（29.30%）andmedicaltechnologists（48.10%）.Sothestudiesstayatalowlevelforalackofsystemiccomprehensionofthebasictheoriesandmethodsofpharmacoeconomics[12],forexample（ⅰ）nostandardizedcourseandnormaltrainingplansforpharmacoeconomics;（ⅱ）nosufficientteacherswithadequatepharmacoeconomicknowledgeandexperiences;and（ⅲ）nostandardizedteachingmaterialofpharmacoeconomics.

2.2InfluenceofPharmacoeconomics

Anotherissueistheinfluenceofpharmacoeconomics.Twofactorswillinfluencetheoptimaluseofpharmacoeconomics:

（ⅰ）thepowerofthepharmacoeconomistachievingchangewithindecisionmakers;and（ⅱ）theperceivedimpactofevaluationoutcomesatalllevelsofdecision-making.

Thefirstfactorisaninformationissue.Astudyshowedthat85.90%decisionmakersregardedthedifficultyofthetransformationofevaluationoutcomtospecificrecommendationsrestraine