Organ of the
GD Society for Dermopharmacy
is a subsection of health economy. As main priorities it deals with the
economic efficiency of pharmaca and therapy methods. On the occasion of
a workshop in the course of the 4th annual meeting of the Gesellschaft
für Dermopharmazie (Society for Dermopharmacy) in Freiburg in May this
year, its significance for the dermatology had been discussed. The workshop
had been presented by Dr. med. Matthias Augustin, the head of a
research group relating to the pharmaco-economy within the dermatology
at the Dermatological Clinic of the Freiburg University. He presented
investigation results according to which treatments of skin diseases by
dermatologists are more cost-effective than by general practitioners.
Pharmaco-economy represents the relation between employed and achieved resources in the medicinal therapy. Resources summarizes the financial employment of diagnostic, therapeutical and preventive measures. The necessity of health-economical investigations can be explained by the fact that in view of the shortage of resources, precise reflections regarding a useful allocation have to be made. In case of increasing requirements it is necessary to assign the available resources in the best possible and just way ensuring the utmost benefit for the patient. The indiscrepancy however between resources, funds and high requirements of medical care can only be solved in a consensus with the society. Health-economy supplies the methods which determine in which fields the resources should be used. Furthermore, it examines the effectiveness of the initiated measures.
Altogether health economy is a growing sector; the number of publications concerning the subjects health economy and quality of life has tripled from 1991 to 1999. It is a striking fact within the field of dermatology that most publications regarding economy refer to wounds, tumors and skin infections. The classical skin diseases as neurodermatitis, urticaria or acne however are surprisingly only represented at a far lower degree.
Input and Outcome are examined
Economy equally serves
in the field of dermatology to assess therapy results. In this context
the employed resources (input) and the effects achieved (outcome) are
compared. On the input side the amount of money invested in the therapy
of a patient respectively the costs of the ambulant and the inpatient
treatment are determined. In former times the outcome had only be raised
in the form of clinical progress, e.g. the degree of severity of skin
diseases whereas today equally the development of costs and the quality
of life during the treatment have become decisive criteria for an effective
therapy result. In the meantime there are validated evaluation procedures
by which a comparison can be drawn between a benefit and the resources
It is essential to establish detailed investigations about the costs accruing. Up to now, mainly the costs for pharmaca had been considered; however this way of proceedings is not at all sufficient. Doctors' fees as well as expenses for inpatient treatment, care preparations and in addition pharmaca and adjuvants are part of the costs in the same way as the ones the patient has to bear himself. The example neurodermatitis shows this very distinctly.
Besides these direct costs accruing at the cost unit and the patient the indirect costs have to be considered as well as productivity losses by disablement, expenses for retraining and early retirement. These expenses relevant for the national economy have to be taken in consideration in the same way for the general calculation as the so-called intangible, not directly measurable expenses. The latter refer to criteria as quality of life and patient satisfaction after realized therapy. Thus for example it has been noticed that Neurodermitis and Psoriasis entail a significant higher degree of strain as tumor diseases.
Significance of Pharmaco-economic Data
Pharmaco-economic data may be consulted as criterion among others for rationally justifiable therapy decisions. Often the question comes up which pharmacon is to be given preference at a given effectiveness. In case the effectiveness is about equal, the decision in favor of the more cost-effective preparation is easy. The situation gets more difficult if a medicament is more expensive and it is necessary to judge whether the higher price is justified by an increased effectiveness and/or an improved quality of life.
At present therapy decisions are both in Germany as well as in many other countries only seldom made in accordance with pharmaco-economic criteria. Budget aspects and personal preferences are rather given special emphasis. The more expensive drug is often even not prescribed if it would be the better and more cost-effective choice in the long run. Short-term saving effects not seldom decide the therapy. An economically useful skeleton legislation for the practice is lacking.
The example of treatment for heavy acne makes clear that a more expensive drug can be the more economical decision. There is a variety of topical preparations which in general do not lead to a lasting healing. More effective is in this case systemical Isotretinoin which has to be applied over a period of four to six months. In the same space of time a patient treated with topical preparations and possibly additionally with a systemical antibiotic gives rise to only a part of the expenses necessary for the systemical Isotretionin. Whereas the therapy with Isotretionin mostly leads to a long-term healing progress, the local treatment and the antibiotic uptake normally have to be effected as a curative therapy being more expensive after two years than the treatment with Isotretinoin. This example clearly shows why guidelines for therapy are urgently required which also consider the economical effects and the influence on the patient's quality of life.
and Drug Assessment
It is to be expected that pharmaco-economic aspects will also play a part regarding the question of cost coverage in future. The admission by itself does not mean that the health insurance companies have to refund the medicament. In the meantime data are asked for Europe-wide which supply evidence for the fact that a drug is also justified regarding its costs. Accordingly a new drug has to prove that it is not only effective but also cost-effective and ameliorates the quality of life.
Equally important are pharmaco-economic data for the quality management. On the basis of cost models it can be examined to what extent pharmacist groups perform effective and quality assured therapies. There is a whole string of investigations which have shown that skin diseases are treated more cost-effectively by dermatologists than by general practitioners. Due to the more professional knowledge the specialist medicine normally the economically more useful alternative.
Activities regarding Pharmaco-economy
within the Dermatology
findings in the field of research concentrate on the basis of the pharmaco-economy
and the methods for data collection of economic factors. Every second
year the Freiburg symposium relating to health economy within the dermatology
takes place in which the expert public is informed about news in this
field. This event which has been organized by the Freiburg Dermatological
Clinic in self-initiative so far will be arranged in cooperation with
the Gesellschaft für Dermopharmazie (Society for Dermopharmacy) starting
with the year 2002.
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