Using Data Generated by Health Economic and Outcomes Research

Cincinnati—Health economic and outcomes research (HEOR) has a role in decision-making, but decision makers at health plans rely most heavily on HEOR to support data on safety and efficacy. At a Managed Care Essentials session at the AMCP meeting, speakers discussed methods of HEOR, how to interpret results, and how to use the data to support decision-making.

The session began with a presentation from Joseph Dye, RPh, PhD, clinical research director, Humana. Dr. Dye reported results of 2 surveys investigating the use of pharmacoeconomic and outcomes research (PEOR) in formulary decision making. The surveys were conducted in 2010 among pharmacy and therapeutic (P&T) committee members and managed care professionals.

The objectives of the P&T survey (PTS) were to evaluate perceptions of the importance of 13 product and manufacturer attributes and the performance of P&T committees on evaluating these attributes. The objectives of the managed care survey (MCS) were to understand current and future use of PEOR data in decision-making.

The PTS was conducted online among 176 managed care pharmacists and examined published formularies to assess the status of cost-effective treatments. The MCS canvassed AMCP members at pharmacy benefit managers, health plans, managed care organizations, Veterans Affairs healthcare centers, and Medicare/Medicaid plans.

In the PTS, 77% of respondents indicated they utilized health economic data as part of the P&T process. Among the managed care professionals responding to the MCS, 74% said they used HEOR in formulary decisions.

Among the MCS respondents, 39% indicated they are increasingly using HEOR, 29% said they currently use HEOR only occasionally, and 33% did not currently utilize HEOR. When asked about use in the future, 40% were certain they would use HEOR, 32% said they would “probably” do so, 18% thought they were likely to use HEOR, and 10% said they would not.

In conclusion, Dr. Dye said there would likely be a growing demand for HEOR, with managed care professionals gaining confidence in the data, particularly as healthcare moves toward a patient-centered focus.

The session continued with a presentation from Diana Brixner, RPh, PhD, professor and chair, department of pharmacotherapy, and executive director of the Pharmacotherapy Outcomes Research Center at the University of Utah College of Pharmacy. Dr. Brixner’s presentation was titled Value Assessment of Technology: The Role of Health Economics and Outcomes Research.

She began by noting that in 2000, national health expenditures were 13.8% of the US gross domestic product. In 2010, the percentage was 17.9%. Per capita, spending rose from $4880 in 2000 to $8400 in 2010.

She then cited 4 goals of efforts at healthcare reform in the United States: (1) deliver near-universal access to US citizens; (2) identify funding and savings; (3) create a system that is sustainable over the long term; and (4) emphasize quality, efficiency, wellness, and prevention to bring about payment reform.

Comparative effectiveness is one way to determine value in the healthcare system, Dr. Brixner continued. She defined comparative effectiveness as the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. She said that the purpose of comparative effectiveness research is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve healthcare at both the individual and population levels.

Health outcomes are, according to Dr. Brixner, “outcomes beyond safety and efficacy, which capture the psychological, social, physical, functional, and economic impact of disease and treatment for the individual and society.” She noted that identification of health-related outcomes has challenges, including identifying the relevant outcomes and valuing those outcomes.

Components of what Dr. Brixner called the “true drug cost” are the drug acquisition costs, preparation costs, the offset of medical costs, the cost of adverse events, and the cost of treatment failures.