Rational Prescribing (RE) Flashcards
What is the aim in achieving efficiency in health care?
Maximum benefit from finite resources available
This may achieved by moving resources from one programme to another.
How is ‘Allocative Efficiency’ applied?
Different groups pitted against one another
OR how to make the best use out of resources you already have
How is ‘Technical Efficiency’ applied?
Application to medicines and pharmacy
Based on drug v drug, drug v surgery, drug v nothing
When evaluating the economics of new drugs what is important to consider in decision making?
Who bears the drug costs
Consider economics beyond acquisition cost; toxicity, monitoring, impact on admissions, cost shifting and primary care
What information is required to license a drug in the UK?
Safety and efficacy data
Placebo controlled studies
Head to head studies aren’t required
Patient groups without co-morbidity
What is the cascade of events in economic decisions for a drug?
Application for marketing license
MHRA
Available to prescribe in the UK
BNF / NHS approved or blacklisted on private Rx only
NICE
PCTS, local formularies, loss of patent, deregulation
What is considered by NICE?
Evidence at an appraisal meeting; epidemiological, clinical evaluations, economic evaluations, expert clinician and patient views, manufacturer’s submissions, availability of alternative medicines
What is the QALY threshold for the NHS?
£20-30k per QALY
£50k in palliative care
What is implicit rationing?
Where neither decisions about forms of care are provided, and the basis for those decisions is also not expressed clearly. Decision maker is not apparent.
What is explicit rationing?
Deciding how to allocate scarce resources
- which Tx should be funded
- who gets the Tx
- who should decide
What should be used to make these decisions
