Social, Behavioral, Administrative, and Economic Pharmacy Sciences
Pharmacoeconomics
Know the four main analyses: cost-minimization (outcomes assumed equal), cost-effectiveness (cost per natural unit, such as cost per life-year), cost-utility (cost per QALY), and cost-benefit (all costs and outcomes in dollars). The incremental cost-effectiveness ratio (ICER) = (cost new − cost old)/(effect new − effect old). If a new therapy is more effective and less costly, it dominates. Perspective matters: societal, payer, and patient perspectives include different costs. Discount future costs and outcomes, and test assumptions with sensitivity analysis. Budget impact differs from cost-effectiveness.
Outcomes and adherence
Distinguish clinical, humanistic, and economic outcomes. Adherence measures include medication possession ratio (MPR) and proportion of days covered (PDC). Quality-of-life instruments include EQ-5D and SF-36. Health literacy, beliefs, and social determinants shape behavior.
Management and informatics
Understand organizational structure, leadership, staffing, inventory control (ABC analysis, just-in-time), continuous quality improvement (PDSA), and SWOT analysis. Informatics concepts include EHRs, CPOE, clinical decision support, barcode medication administration, e-prescribing, interoperability (HL7/FHIR), and HIPAA privacy rules. Alert fatigue is a major implementation trap.
Traps
Do not compare a cost-benefit ratio in dollars with a cost-effectiveness ratio in dollars per QALY. Do not ignore the perspective when comparing studies. Do not discount costs in the first year.
Worked example
New drug costs $10,000 and yields 2.0 QALYs; old drug costs $6,000 and yields 1.5 QALYs. ICER = ($10,000 − $6,000)/(2.0 − 1.5) = $4,000/0.5 = $8,000 per QALY.