Search | Feedback | Contents | Deutsch
Organ of the

 GD — Society for Dermopharmacy

Issue 2/2006
Issue 1/2006
Issue 2/2005
Issue 1/2005
Issue 1/2004
Issue 2/2003
Issue 1/2003
Issue 2/2002
Issue 1/2002
Issue 4/2001
Issue 3/2001
Issue 2/2001
Issue 1/2001
Issue 1/2000
More Links:
Society for


Issue October 2000

Workshop Pharmaco-economy
Significance for Dermatology

Pharmaco-economy 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 employed.

Direct costs: example neurodermatitis

Cost unit

Drug   Patients' costs participation
Care preparations   Traveling expenses
UV-therapy   Care preparations
Outpatient fees   Nutritional extra costs
Inpatient therapy   Material extra costs
Medicine and adjuvants   Information material

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

Latest 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.

The significance of the pharmaco-economy within the dermatology is also reflected in different prizes. Thus the treatises by the Freiburg research group regarding pharmaco-economy within the dermatology headed by Dr. Augustin have got the award "Lilly Quality of Life Award" which has been awarded to dermatology for the first time and the "Wersbach-Preis für Psychosomatische Dermatologie (Wersbach-prize for psychosomatic Dermatology)". This year Augustin has received the "Hermal Förderpreis zur Pharmakoökonomie (Hermal award for pharmaco-economy)".

In the meantime guidelines concerning the assessment of quality of life within the dermatology have been established elaborated by a working group of the Deutsche Dermatologische Gesellschaft (German Dermatological Society) in Germany. The dermatology is so far the only discipline having edited such guidelines.

The studies in the field of pharmaco- respectively health economy within the dermatology call for an interdisciplinary cooperation and a dialogue between the groups of interest as politicians, health insurance companies, the pharma industry, physicians, pharmacists and patients. The coordination of activities will be made in future by the newly created Department Dermatotherapy of the Society for Dermopharmacy.



October 2000 Copyright © 2000 - 2014 Institute for Dermopharmacy GmbH. Contact: