Pharmacoeconomic evaluations and primary care prescribing
This study aimed to investigate the effect of incorporating adverse drug reactions in economic analyses of drug therapies. Subsequently, the impact of this information on prescribing in primary care is explored. In order to achieve the aims of the study, three main studies were conducted. In the first study, an economic analysis was conducted to estimate the comparative costs of a large UK population (N = 98 887) given nonsteroidal anti-inflammatory drug (NSAID) therapy alone and in combination of gastrointestinal (GI) protective agents including concomitant prescriptions of H2 blockers, omeprazole and misoprostol. The second study was a pharmacoeconomic analysis, using data from the literature and local expert opinion, of three commonly prescribed classes of drugs in primary care – NSAIDs, selective serotonin reuptake inhibitors (SSRIs) and angiotensin converting enzyme (ACE) inhibitors for the treatment of rheumatoid arthritis, depression and hypertension respectively. Finally, the results from the pharmacoeconomic analysis were disseminated to GPs in a local Health Board to explore the impact on influencing primary care prescribing. Economic analyses based on various data sources have shown that the total cost of drug therapies are often much higher than the purchasing cost alone. There is much value in taking into account the clinical and economic impact of drug-induced ADRs when conducting pharmacoeconomic evaluations. However, this is often restricted by the availability of some of the data that are required to complete the economic model. The necessary data do exist, but linked clinical data for this type of analysis are not readily available for research purposes. General practitioners were generally supportive of economic evaluations and the exploratory study on disseminating pharmacoeconomic information. However, the dissemination exercise had failed to demonstrate a positive relationship. In addition to the barriers highlighted in the literature, it was found that GPs do not feel that there is a role for the implementation of economic information in primary care.