CHAPTER 9

OUTCOMES EVALUATION
OF PHARMACY
OPERATIONS
Created by:
Arlene B. Aguila
Cielo Aeb Quintia

LearningObjectives
Discuss the different facets of the ECHO model and their
application to evaluating existing and proposed pharmacy goods,
services and operations.
Describe differences among five types of economic analyses as
tools for managerial decision-making.
List the advantages and disadvantages of the various methods of
measuring humanistic outcomes, and describe the role that
humanistic outcomes play in evaluating goods, services, and
operations.

 Identify the objectives of a service and determine the types of

outcomes a pharmacists would need to measure in a pharmacyrelated service.
Identify the advantages and disadvantages of the various methods
used to collect data when evaluating services.
List and describe the uses of various outcomes evaluations and
assessment.

INTRODUCTION
Pharmacists make many contributions
that improve
the lives of their patients on a daily basis.
These contribution as range from catching a
drug interaction, counseling a patient about
his or her medication, or even
providing a new value-added .
While many pharmacists would like to
offer these value-added services to their
patients, they can have upfront costs that
cannot be ignored. How can pharmacists
provide these services and show that they
both help their patients and actually decrease
the overall cost of care? Many studies have
been conducted that show that pharmacists
can make a difference both in cost and in the
quality of their patients lives.

Pharmaciststoimprovethe
livesoftheirpatientsor
customersindaytodaylives.

Framing Questions
How does one start documenting the value
of a pharmacy service?

FIRST STEP: Define the problem or research

question being addressed.
Stating the problem upfront seems rather obvious, but it is
not always done. Many pharmacists waste time and energy trying
to answer poorly defined questions.
.

SECOND STEP: Define the

Objectives.
After the problem has been stated,
the next step is to define the objectives.
A very broad problem will result in
broadly defined objectives. On the other
hand, if the problem is addressed more
narrowly, a more narrowly defined
objective could be studied..

THIRD STEP: Establish a framework to evaluate the

question.

When establishing the framework,

pharmacists need to know some basic facts
about the programs and diseases they are
studying. Pharmacists undertaking these
projects first should prioritize their objectives
by determining what interventions and
outcomes most need to be evaluated.

SELECTING THE VARIABLES TO

MEASURE
Many health care organizations make the mistake
of focusing on only one area of health care when trying
to reduce the overall cost of health care. Evaluating the
cost of a single aspect of patient care in isolation from all
other aspects is commonly known as component
management.

Example of component management include

focusing on the costs of drugs or laboratory tests without
looking at the impact of these costs on overall health
care costs or outcomes. Unfortunately, many health
studies have focused on just one type of cost without
considering the overall care of patients.

 Disease management
strives to consider all individual components
of health care for a specific disease with a
view toward an outcome that is important for
successful management of that disease.
Instead of dealing with one element at a time
(such as prescription costs only), disease
management attempts to control the disease
by integrating the components of health care
to provide the best total patient outcomes at
the most reasonable cost.

IDENTIFYING CONFOUNDING
VARIABLES THAT CAN AFFECT
OUTCOMES
After identifying
a research question, study
objectives, and variables to evaluate,
researchers also need to think about other
variables that may affect the results of the
study.
Any variable that also may have an impact on the
results of study but is not one of the primary variables
being evaluated is known as a confounding variable.

ECHO
MODEL
Economic
C- linical
Humanisti
c
Outcomes

Outcomes
research is defined as

studies that attempt to

identify, measure, and
evaluate the end results of
health care services.
Outcomes research may
evaluate not only the clinical
effects of health care
services but also the

ECHO
MODEL
Economic
C- linical
Humanisti
c
Outcomes

Many have proposed that

evaluation of drug therapy and
pharmacists value-added
services should include
assessments of economic,
clinical, and humanistic
outcomes. The economic,

clinical, and humanistic

outcomes (ECHO) model

assumes that the outcomes of

medical care can be classified
along the three dimensions of

ECHO
MODEL
Economic
C- linical
Humanisti
c
Outcomes

Economic outcomes are

defined as the direct, indirect, and
intangible costs compared with the
consequences of medical treatment
alternatives
Clinical outcomes are defined as
medical events that occur as a result
of disease or treatment.
Humanistic outcomes are
defined as the consequences of
disease or treatment on patient
functional status or quality of life. All
three of these outcomes need to be

Economic
Outcomes

Traditional costcontainment measures are

not always consistent with
improved patient care. Thus
attention has turned toward
demonstrating the value of
health care. A full evaluation
of relevant costs and
consequences differentiates
outcomes research from
traditional cost-containment

Economic
Outcomes

Costs are defined as the value of the

resources consumed by a program or treatment
alternative.
Direct costs are the resources consumed in
the prevention, detection, or treatment of a
disease or illness. These costs can be divided into
direct medical and direct nonmedical costs.
Direct medical costs are specific monetary
transactions associated with paying for medical
care, such as hospitalizations, drugs, medical
supplies, and physician visits.
Direct nonmedical costs involve monetary
transactions for required items or services that do
not involve purchase of medical care. Examples
include transportation to medical facilities, special
foods, and the time that family members miss

Economic
Outcomes

Indirect costs are the costs that result from

morbidity and mortality. These costs are related

to changes in work production, such as costs
incurred from missing work (absenteeism), costs
incurred from decreased productivity despite
presence at work (presenteeism), or costs
incurred owing to premature death.

Intangible costs are the costs incurred that

represent nonfinancial outcomes of disease and

medical care and are not expressed in monetary
terms. These include pain, suffering, and grief.

Consequences are defined as the effects,

outputs, and outcomes of the program or
treatment alternative

Typesof
Economic
Evaluation

The basic task of economic

evaluations is to identify, measure,
value, and compare the costs and
consequences of the alternatives
being considered. Five types of
economic analyses can be used to
examine treatment alternatives:
cost of illness
cost-minimization analysis
cost-benefit analysis
cost-effectiveness analysis, and
cost-utility analysis

Typesof
Economic
Analyses

COST OF ILLNESS
involves identifying all the direct
and indirect costs of a particular
disease or illness from a particular
perspective (e.g., patient, payer, or
society). This method, often
referred to as burden of illness,
results in a total cost of a disease
that can be compared with the cost
of implementing a prevention or
treatment strategy.

Typesof
Economic
Analyses

COST-MINIMIZATION ANALYSIS
is a tool used to compare two or
more treatment alternatives that
are assumed to be equal in efficacy.
It simply compares the direct and
indirect costs of treatment
alternatives in dollars and does not
consider the outcomes of the
treatments (because they are
assumed to be the same).

Typesof
Economic
Analyses

COST-BENEFIT ANALYSIS
is used when the outcome
can be expressed in
monetary terms, such as in
the amount of money an
HMO might save if it
implements a new program.
The direct and indirect costs
of a program or intervention
are measured as they occur.

Typesof
Economic
Analyses

COST-EFFECTIVENESS
ANALYSIS
is used when the treatment
alternatives are not
therapeutically equivalent or
when outcomes cannot be
expressed in monetary units.
Cost-effectiveness analysis
allows researchers to
summarize the health benefit
and resources used by two or
more competing programs so

Typesof
Economic
Analyses

COST-UTILITY ANALYSIS
is used when quality of life is
the most important outcome
being examined. This is
common in disease states in
which how one feels or what
one can do is more important
than a clinical laboratory value
or economic outcome (e.g.,
chronic diseases such as heart
disease, diabetes, arthritis,
cancer, or HIV/AIDS).

Usesof
Economic
Outcomes

Many benefits can be realized

by applying pharmacoeconomic
principles and methods to
evaluating pharmacy services.
Economic assessments can assist
in balancing cost and outcome
when determining the most
efficient use of health care goods
and services. Economic
assessments are helpful in
optimizing clinical decision
making.

Usesof
Economic
Outcomes

Decision analysis

is a
technique used in economic
evaluations to structure the logical
and chronologic order of the analysis.
It is a systematic, quantitative
method of describing clinical
problems, identifying possible courses
of action, assessing the probability
and value of outcomes, and making a
calculation to select the optimal
course of action. A tool used in
decision analysis is a decision table or
decision tree. A decision tree, will be

Decision
Tree

allows researchers to display graphically all

treatment alternatives being compared, the
relevant outcomes associated with these
alternatives, and the probabilities of these
outcomes occurring in a patient population.

Usesof
Economic
Outcomes

In economic evaluations, there is a need to

make assumptions about the variables in the
analysis. It is important to keep in mind that
assumptions are simply predictions about what a
researcher thinks might happen as a result of a
program or intervention. To account for the variety
of outcomes that may arise in any intervention,
researchers should use a technique known as
sensitivity analysis.
Sensitivity analysis is a tool that tests
the robustness or strength of economic
evaluation results and conclusions by making
different assumptions about outcomes over a
range of plausible results.

Clinical
Outcomes

To health care professionals, the most

obvious variables that should be
addressed when evaluating any
medical intervention are the clinical
outcomes. Any value-added service
can assert that patients will receive
better care if given that service.
Clinical outcomes vary with each
disease state but should include any
pertinent medications

Quality of life refers to an

Humanistic
Outcomes

evaluation of all aspects of our lives,

including where we live, how we live,
how we play, and how we work.

Health-related quality of life

(HRQoL) encompasses only those
aspects of life which are dominated or
influenced significantly by personal
health or activities performed to
maintain or improve health.

Economic
Evaluation

Costs of goods and services seem

intuitively simple to quantify.
However, a number of potentially
complicated issues must be
considered. When identifying the
goods or services, will the actual cost
(wholesale cost) to the pharmacy or
health care organization be
measured, or will the charge to the
patient or payer (retail cost) be
measured? Sometimes access to cost
data may be limited, or the data may
be entirely unavailable.

Clinical
Evaluation

Pharmacists have the ability to assess

patients for general signs and symptoms of
many disease states. In many states,
pharmacists are also able to check blood
glucose and lipid levels. They are able to
measure peak flows in pulmonary patients
and can assess minor skin abnormalities
and wound care. All these clinical variables
may be recorded at baseline and at each
subsequent visit to chart changes and/or
improvements in the patients condition

Humanistic
Evaluation

Humanistic outcomes generally are obtained

directly from patients in the form of
standardized questionnaires. There are two
steps when collecting humanistic information.
First is to identify the best and most
appropriate survey or surveys to use (general
or specific), and second is to decide how to
administer the HRQoL instruments or surveys.
Usually, clinicians and/or researchers choose
both general and specific HRQoL instruments
so that all elements related to a patients
quality of life are covered in the study.

Humanistic
Evaluation

A patient satisfaction survey that has

been used in a similar setting also may
be administered. Clearly, the more
information gathered, the more
complete the picture will be. However,
beware of respondent burden, or the
time and energy it takes patients to
complete the group of surveys.

Data
Assessment

After the data collection is completed, the

data must be analyzed and assessed to
interpret the results and
reach meaningful conclusions.
Baseline data
Prior to implementing the intervention,
demographic, clinical, and humanistic
information should have been collected.

UsesOf
Outcomes
Evaluation

Assessment of success or failure of a

program or service
Contributing to the quality
improvement programs
Development of additional services
Reassessing the service objectives

The End of our

Report !!!
Thank you for
Listening

Created
by:
Arlene B.
Aguila
Cielo Abie
Quintia