Pharmaceutical Economics & Health Policy Editorial Comment Pharmaceuticals remain the most cost-effective therapeutic modality known to modern medical science. Although in 1995 they constituted approximately 12% of international health care expenditures, pharmaceuticals represent a significant and increasing fiscal commitment for both public and private insurance programs. The escalation in pharmaceutical expenditures can be attributed to a multitude of factors, including the increased expense associated with the development and introduction of a new chemical entity, a shortened product life-cycle, advances in biotechnology, and an aging population whose members consume an increasing number of medications. These factors have stimulated an international interest in assessing both the cost-effectiveness of pharmaceuticals and regulatory methods for containing financial commitments to their procurement under both public and private health insurance initiatives.1 Traditionally, international regulatory requirements have focused on the efficacy, safety, and quality of pharmaceutical compounds. However, factors governing the entry of pharmaceutical compounds into clinical practice are rapidly changing, with an increasing emphasis on economic appraisal. The first national government to signal such an intention was the Commonwealth Government of Australia, which, in 1993, began to require economic evaluations in support of applications for coverage of new pharmaceutical compounds under the federal Pharmaceutical Benefits Scheme. 2 This requirement was supported by legislation mandating that Australia's Pharmaceutical Benefits Advisory Committee consider both expense and effectiveness when formulating recommendations to the national government. Similarly, the Ontario Drug Quality and Therapeutics Committee and subsequently the Canadian federal government have adopted guidelines for the economic evaluation of pharmaceuticals that are to be covered by public insurance programs) These events portend significant changes in the allocation of financial resources and human capital within the pharmaceutical industry and governmental agencies. The quality of the analyses as well as the nature of the relationship between the researcher and the pharmaceutical industry will be of paramount importance as these investigations shape health care policy and thus the allocation of scarce resources. In their commentary, Drs. Mullins and Ogilvie examine various international guidelines for the economic appraisal of pharmacotherapy and offer a perspective on the benefits and disadvantages of standardization. Schizophrenia is a major psychotic disorder that can impair all aspects of a patient's life and that carries a high risk of suicide and other life-threatening conditions. 4 Because of its early age of onset and chronic nature, schizophrenia is an illness with profound economic impact on patients, their families, and society at large. While schizophrenia affects only 1% of the population, it accounts for 2.5% of total health care expenditures in the United States. In 1993, treatment of schizophrenia was estimated to total $40 billion in direct and indirect treatment costs. 5 Drs. Procyshyn and Zerjav present a retrospective appraisal of financial and clinical outcomes stemming from receipt of pharmacotherapeutic options for the treatment of schizophrenia. 1192
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Nonsteroidal anti-inflammatory agents (NSAIDs) are widely prescribed in the treatment of osteoarthfitis and rheumatoid arthritis. 6 Although NSAIDs are effective in providing relief from the pain and inflammation of arthritic conditions, adverse events resuiting from the use of these medications are more frequent than with any other category of pharmacotherapy. Studies indicate that 38% to 50% of NSAID users experience dyspepsia, 15% to 22% consistently develop endoscopically proven gastric ulcers, and 1% to 2% develop gastrointestinal hemorrhage or perforation. 7 Dr. Simon et al. examine the gastrointestinal safety and financial impacts of various NSAIDs used in the long-term management of arthritis. I trust the readership will find these articles to be of interest and value. David Alexander Sclar, BPharm, PhD Section Editor REFERENCES 1. Pausjenssen AM, Detsky AS. Guidelines for measuring the costs and consequences of adopting new pharmaceutical products: Are they on track? Med Decis Making. 1998;18(Suppl 2):S 19-$22. 2. Hailey D. Australian economic evaluation and government decisions on pharmaceuticals, compared to assessment of other health technologies. Soc Sci Med. 1997;45:563-581. 3. Baladi JF, Menon D, Otten N. Use of economic evaluation guidelines: 2 years' experience in Canada. Health Econ. 1998;7:221-227. 4. Vuksic-Mihaljevic Z, Mandic N, Barkic J, Laufer D. Psychiatry: Schizophrenic disorder and social functioning. Clin Neurosci. 1998;52:21-27. 5. Zito JM. Pharmacoeconomics of the new antipsychotics for the treatment of schizophrenia. Psychiatr Clin North Am. 1998;21:181-202. 6. Haslock I. Clinical economics review: Gastrointestinal complications of non-steroidal antiinflammatory drugs. Aliment Pharmacol Ther. 1998;12:127-133. 7. Eccles M, Freemantle N, Mason J. North of England Evidence Based Guideline Development Project: Summary guideline for non-steroidal anti-inflammatory drugs versus basic analgesia in treating the pain of degenerative arthritis. The North of England Non-Steroidal AntiInflammatory Drug Guideline Development Group. BMJ. 1998;317:526-530.
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