An introduction to pharmacoeconomic evaluation in rheumatology

Pharmacoeconomics is a relatively new healthcare discipline that borrows from several disciplines including health economics, decision analysis and evidence‐based medicine. By using various techniques such as cost‐minimization analysis (CMA), cost‐effectiveness analysis (CEA), cost‐utility analysis (CUA) and cost‐benefit analysis (CBA), pharmacoeconomic evaluation attempts to instil the element of cost‐effectiveness into the clinical decision‐making process beyond the traditional approach of considering efficacy and safety. The ultimate aim of pharmacoeconomics is to assist the decision makers in achieving allocation efficiency in the healthcare system. This is in response to the increased need for accountability during the age of cost‐containment in healthcare. The rapidly increasing healthcare costs and the ageing of populations in the developed countries have contributed significantly to the need for consideration of effectiveness in the evaluation of any healthcare treatment, particularly in pharmaceuticals. The growth of this field has proceeded rapidly in the past decade as health policy makers have faced a continuing series of decisions about funding new clinical therapies in an era of increasingly constrained healthcare resources. However, economics of healthcare includes not just an assessment of the cost of a new therapy, but an assessment of its overall economic and clinical impact. The discipline of pharmacoeconomics is developed to fulfil this role. To date, the most successful applications of the principles of pharmacoeconomics are in the areas of purchase decision (e.g. decision for formulary inclusion), subsidy decision (e.g. level of subsidy for pharmaceuticals), establishing practise standards (e.g. development of clinical practise guidelines) and assessment of technologies (e.g. medical procedures and technologies). The proper application of pharmacoeconomic evaluation in clinical medicine would necessitate a multidisciplinary approach requiring expertise and inputs from practitioners from clinical medicine, biostatistics and psychometrics, among others. A properly conducted pharmacoeconomic evaluation would provide valuable insights for clinicians to allow the choosing of options representing the best value‐for‐money without compromising the quality of care delivered. The application of pharmacoeconomic principles in the practise of rheumatology will be illustrated using the example of a hypothetical example of evaluating an application for formulary inclusion of a COX‐2 inhibitor.     

Appropriate use of non-steroidal anti-inflammatory drugs in rheumatology: guidelines from the Spanish Society of Rheumatology and the Mexican College of Rheumatology

ObjectiveTo develop guidelines for the appropriate use of NSAIDs in rheumatology.MethodsWe used a methodology modified from the one developed by RAND/UCLA. Two groups of panellists were selected, one by the CMR and another by the SER. Recommendations were proposed from nominal groups and the agreement to them was tested among rheumatologists from both societies by a tworound Delphi survey. The analysis of the second Delphi round supported the generation of the final set of recommendations and the assignment of a level of agreement to each of them. Systematic reviews of five recommendations in which the agreement was low or was divided were also carried out.ResultsHere we present recommendations for the safe use of NSAIDs in rheumatic diseases, based on the best available evidence, expert opinion, the agreement among rheumatologists, and literature review. The trend is to reduce the frequency, duration and dose of NSAIDs in favour of non-pharmacological measures, analgesic drugs or disease modifying drugs. In addition, the recommendations help to identify profiles for increased toxicity, with an emphasis on gastrointestinal and cardiovascular risks. The recommendations deal with the course of action and monitoring in different risk groups and in patients using antiplatelet or anticoagulant drugs. The overall level of agreement is high.ConclusionsThe NSAIDs are safe and effective drugs for the treatment of rheumatic diseases. However, it is necessary to individualize its use according to their risk profile.     

再谈风湿科医师的任重与道远

10年前笔者在本刊的前身《风湿病学杂志》的“青年医生园地”发表一篇笔谈《风湿科医师的任重与道远》，呼吁重视风湿免疫科的建立和发展。10年后的今天，笔者已经人到中年，最近被抽调去参加了卫生部专科医师培训基地的书面资料审核和部分基地的实地审核，目睹全国各地风湿免疫科仍然显著地滞后于内科系统中的其他三级学科。与10年前一样，仍有许多医学院校的附属医院和省市级的大医院没有建立风湿科，仍然有许多风湿免疫科医生和爱好风湿免疫科的年轻医生感觉到创业难。有感而发，再谈风湿科医师的任重与道远。     

Rheumatology training in the UK: the trainees' perspective - issues surrounding paediatric rheumatology

We read with interest the letter by Foster et al. highlightingthe problems relating to paediatric rheumatology in the UK.Paediatric rheumatology is certainly one of the subspecialtiesin need of better provision for training as well as deliveryof care. Whilst subspecialties like primary care rheumatology,for example, suffer substantially due to suboptimal communicationbetween primary care and     

Regional rheumatology meetings. British Society for Rheumatology Research, Training Subcommittee

SIR, In 1998 the British Society for Rheumatology (BSR) Researchand Training Subcommittee wrote to representatives of each regionin the UK asking for details of their regional rheumatologymeetings. The objective was to collect information about thecontent and frequency of rheumatology meetings being held acrossthe UK. The rationale was that it was considered within theremit of the Research and Training Subcommittee to ensure that     

风湿病学发展的点滴思考

当迈入21世纪,风湿病学已成为临床医学领域最为活跃的学科之一。从近期发布的科学引文索引(SCI)论文影响因子(IF值)数据可以发现,风湿病学代表性国际刊物Arthritis&Rheumatism(美国风湿病学会官方杂志)的IF值从2008年的6.787上升至2010年8.435;而Annals of the Rheumatic Diseases     

风湿病学科发展之路和思考

山西医科大学第二医院风湿科于1990年成立,建科伊始专科医务人员少,业务开展较困难,经过多年艰辛的努力,科室的建设得以迅速发展和壮大.1995年由科室牵头成立了山西医学会风湿病学专业委员会,2009年成立了山西医师协会风湿免疫科医师分会,至今省内风湿专科医师已达300余人,标志着山西省风湿学科的发展到了一个新的水平.     

Rheumatology capacity building: implementing a rheumatology curriculum for Liberian health-care providers in 2016

Clinical Rheumatology - Liberia has no rheumatology providers for the nation’s 4.7 million people. We proposed a short course format rheumatology curriculum to educate Liberian providers as...     

Audit of rheumatology services for adolescents and young adults in the UK. British Paediatric Rheumatology Group

BACKGROUND: Juvenile idiopathic arthritis (JIA) is associated with significant morbidity in adulthood with at least one third of children continuing to have active inflammatory disease into their adult years and up to 60% of all patients continuing to have some limitation of their activities of daily living. A survey of service provision for these young people in the transition from paediatric to adult rheumatology care was therefore undertaken. METHODS: A postal questionnaire was sent to all 92 members of the British Paediatric Rheumatology Group, representing 61 units providing a paediatric rheumatology service in the UK and Eire. RESULTS: Fifty-five replies were received representing a 60% completion rate of doctors and 84% of units on the mailing list. The majority of respondents were adult rheumatologists (n = 36, 65%) with 42% of respondents based in teaching hospitals. A median of 24 patients (new and follow-up, range 1-225) were seen in a median of two paediatric rheumatology clinics (range 0-15) per month. Eighteen per cent of units had a dedicated adolescent clinic (n = 9) with a median of one clinic per month and a median number of new patients per month of two (range 0-24) and 10 review patients (4-32). All the adolescent clinics involved an adult rheumatologist with five having a paediatrician in clinic and four having access to a paediatrician. The majority of clinics involved a specialist registrar (n = 6), a nurse specialist (n = 6), an occupational therapist (n = 6) and a physiotherapist (n = 5). The majority of clinics had flexible entry and exit criteria. In seven clinics there was a standardized process of transfer, first discussed at a median age of 13 yr (range 12-16) but no unit provided literature or organized pre-visits for this process. A demand for patient information resources (e.g. disease and drug information, careers) specifically aimed at adolescents with rheumatic diseases was identified. Generic health issues were only addressed by two clinics. Obstacles to current service provision and ideas for future developments were identified. CONCLUSIONS: This survey identifies a heterogeneity of provision of healthcare for adolescents with rheumatic disease and highlights the potential for further research and development.     

Systematic reviews and meta-analysis in rheumatology: a gentle introduction for clinicians

Clinical Rheumatology - Given the plethora of studies today on the same topic, clinicians in rheumatology as well as others increasingly rely on systematic reviews, with or without meta-analysis,...