Mexico is still battling with treatment shortages that have only worsened due to the dwindling budget assigned to the healthcare sector. A thorough analysis of innovative therapies and their long-term impact on patients, beyond their initial cost, could prove a boon for the burdened health system, however.
Pharmacoeconomics can be defined as the branch of economics that uses cost-benefit, cost-effectiveness, cost-minimization, cost-of-illness and cost-utility analyses to compare pharmaceutical products and treatment strategies. “What a healthcare system saves in unnecessary treatments can be used in more medications, medical devices or diagnostic tests for more patients,” explains Herman Soto, Founder of HS Estudios Farmacoeconómicos.
According to Soto, pharmacoeconomics might sometimes introduce innovation that could be more expensive than the treatments currently used. However, it provides better outcomes and reduces hospitalizations and adverse effects, making it more efficient and better for the system’s finances.
Working with a limited budget prevents administrations from providing every treatment to every individual, which pushes healthcare systems to make hard choices to provide the best treatments for as many individuals as possible. “In Mexico, this might mean not centralizing technology in the center of the country and providing the best possible treatments to every state,” Soto says. Pharmacoeconomics are necessary to improve this decision-making to ensure the best health and economic outcomes.
The first key component when carrying out a pharmacoeconomic evaluation is the identification of the various costs involved, which are usually direct medical, direct non-medical, indirect and intangible costs, according to Pharmacy Practice. Direct costs refer to those paid directly to healthcare service providers for the patient’s treatment. The medical or nonmedical classification depends on whether they refer to actual medical procedures or other supporting associated costs. Indirect costs refer to those experienced by patients, family or society as a result of the treatment, like the loss of earnings or productivity resulting from a patient’s illness. Intangible costs are attributed to suffering that comes from illness or healthcare interventions.
The second component of this economic analysis is the outcome to be measured or the expected benefits from an intervention. This analysis looks to integrate all the different impacts on a patient’s life as a result of the intervention. “The defined benefits can be measured in natural units and utility units. For instance, natural units can mean years of life gained or events prevented, such as strokes, surgeries, among others,” explains Pharmacy Practice. Utility units are frequently informed by some measurement of “quality of life” in different disease states. These, Pharmacy Practice explains, can be physical, social and emotional aspects of the patient’s well-being, which may not be directly measurable in clinical terms.
A study by the Iberian-Latin American Pharmaceuticals Organization highlights a case in Oaxaca where medicines were collected in the community of Teotitlán de Flores Magón. Researchers found two significant challenges to successful outcomes, the first being adherence to treatment. “It is necessary to direct strategies for patients to increase their adherence to treatment while considering the pharmacotherapeutic follow-up to guarantee the expected results,” states the study. The second challenge was the use of expired or unused medicines due to their prolonged lifespan at a family home, which hindered the result of the treatment. Thus, the study recommended the implementation of a Unit Dose System with the purpose of maximizing pharmaceutical resources as well as minimizing the use of expired drugs.
Time also plays a fundamental role in these studies. “The choice of time horizon is an important decision for economic modeling and depends on the nature of the disease and intervention under consideration and the objectives of the analysis,” says Pharmacy Practice. The time to begin the studies usually is during the clinical development stage of a drug, including some post-marketing research. “Once a drug is marketed, epidemiological studies to understand the natural progression of the disease comorbidities and treatment would enable estimation of the variables that might have pharmacoeconomic implications with regard to the cost of illness and quality of life,” says Bootman.
There is still little data on pharmacoeconomics in Mexico; however, the Professional Society for Health Economics and Outcomes Research (ISPOR) studied Mexico’s evaluation scheme of treatments for people in terminal phases and found that the Basic Table and Catalog of Health Sector Supplies (CBCISS) is considered an essential instrument in the regulation for the introduction of health technologies. Meanwhile, the General Health Council (CSG), as a national health authority, complements, converges and aligns the efforts that the different health institutions make to update the CBCISS, using mechanisms based on scientific evidence, standardized criteria and transparent processes, focused on the health needs of the Mexican population.
The purpose of the CBCISS is to collaborate in optimizing public resources destined to healthcare through the use of technologies that have proven their safety, therapeutic efficacy and efficiency. This resulted in a dynamic instrument of continuous development to be reviewed periodically to adjust it to new innovations and the epidemiological panorama of the moment.
ISPOR found that Mexico’s limited resources impact the allocation of more funds for the care of patients in terminal stages, which leads to a decrease in resources in cost-effective measures to save lives. ISPOR explains that faced with these challenges, each country develops different strategies, according to its context and its resources.
Omar Tomey, Medical Director of AbbVie, says that pharmacoeconomics should not be an isolated subject for the highest levels of the Ministry of Health. “Many decision-makers in hospitals are not doctors but specialists in pharmacoeconomics and health economics, so it is key for young doctors to understand the subject. The education of future decision-makers will be key in ensuring a better health system, so it is imperative that they have the right education and tools to remain informed,” Tomey says.