Industry careers for pharmacoeconomists
pharmafile | October 21, 2003 | Feature | Business Services |Â Â careers, pharmacoeconomists, recruitmentÂ
The last five years have seen a shift in pharmacoeconomics to the centre of corporate concerns. Pharmacoeconomics used to be seen as part of the world of strategic planning and drug development. Now drug acceptance and sales may often depend on the results of economic studies. The next generation of chief executives will want to show this experience on their curricula vitae. Pharmacoeconomists have come out of the backroom into the arena where company reputations are won or lost.
Pharmacoeconomics used to be seen in the industry as a negative force, which would be used by regulators to block the introduction of new therapies. However, companies have shown how they can adapt and use the new discipline to a more positive end. Pharmacoeconomics has generally provided evidence which has favoured new therapies. The coming of pharmacoeconomics has been associated with a period of rapid growth in spending on pharmaceuticals first in the USA and then in the UK. While clinical trials of effectiveness have become more difficult and expensive and have shown a higher failure rate, economic studies have tended to show more positive results.
The greater use of economics has been associated with a new healthcare paradigm. Healthcare is not just about doctors treating individual patients. It is about reducing risks across local populations. Health funders have to reach out to ensure that high-risk individuals get access to treatment. For agencies such as health maintenance organisations (HMOs) there is an element of interest as well as a professional duty in this. Preventive treatment now may reduce hospital admissions and treatment costs in the future.
Within the UK the new paradigm has been expressed in the graduated treatment plans of the national service frameworks which have encouraged rapid diffusion of statin use for coronary heart disease and set standards for reducing risk of progressive disability in diabetes.
The use of economics has also coincided with the rise in influence of informed groups of patients. Such groups have been able to use economics to get much more focus on rarer diseases with smaller patient groups. Economic studies have brought into focus the longer-term costs and benefits involved in treatment of these groups. This has reinforced the supply side change by which smaller pharmaceutical companies have sought to develop new niche markets.
The work of pharmacoeconomists
The range of jobs open to economists in this field is now much wider. The subject has also become much more international. With increasing numbers of governments now requiring cost-effectiveness studies for reimbursement, health/pharmacoeconomists are no longer concentrated in the USA and the UK: they are found around the globe. An international labour market is likely to develop and expand, and future careers are likely to involve an increasing amount of international experience and travel.
Clinical trials
The original role of economists was in contributing an additional dimension to clinical trials. Data would be collected during the course of the trial and then towards the end of the trial additional economic analysis would be carried out. This would cover:
- detailed costing of alternative therapies
- estimates of resource savings from more effective therapies
- estimates of costs to patients from treatment.
This role of economics in adding to clinical trials has indeed expanded so that a large clinical trial will have an economics component, which will be reported separately. Clinical trial results may also be used for modelling economic costs and benefits in the future.
Cost-effectiveness
To the old hurdles of safety, efficacy and quality has now been added the fourth hurdle of cost-effectiveness. This means in effect a second period of time before the general adoption of new therapies after the initial period while agencies make decisions on the first three issues. The coming of the fourth hurdle of economic efficiency has been the single most important event affecting health economics over the past decade. The new role of economists is in using trial evidence for external presentation for regulators, and the central place here of cost-effectiveness has transformed their role and workload, bringing them and the frontline company success or failure.
Since 1997 Denmark, England and Wales, Finland and the Netherlands have all introduced systems for collecting economic evidence to justify reimbursement. The National Institute for Clinical Excellence (NICE) in England and Wales is emerging as a key international leader.
NICE adds an extra element of intense scrutiny drawing on experience from a wide range of reports, reviewing 40-50 new and existing technologies a year. The NICE approach will also increase and sharpen comparisons between drug therapy and other types of therapy in surgery or health promotion. For the first time an agency will be reviewing all kinds of therapy on a consistent basis. NICE sees its role as moving up the quality care in healthcare and it has gained credibility with health professionals although not with the wider public. In practice most new technologies and therapies submitted to NICE have generally been accepted. The failure rate has been far lower than with the US Food and Drug Administration (FDA), which is now the main source of scrutiny of the two-thirds of new drugs which are first launched in the US market.
Within the USA the new challenge of cost-effectiveness has come not from the Federal government but from HMOs and insurers. The FDA's initial assessment and approval of new products is made purely on the basis of safety, quality and efficacy, although the FDA does have a later role in approving any promotional material which mentions economic assessment or economic evidence.
Marketing
Pharmacoeconomists also contribute to marketing once a drug therapy is accepted for funding. There are many new challenges in relating to patient groups. One particular kind of study provides a vital link between marketing and the concerns of the regulators. These are the studies of the burden of disease. These provide estimates of current and prospective treatment costs together with estimates of the economic and personal losses arising from morbidity. They bring together data from the health service on admission rates and treatment patterns with data from the wider society about the impact of illness on income and on withdrawal from the workforce. The burden of disease studies has provided new evidence both on costs to patients and on longer-term treatment costs. They have powerfully reinforced the case for early intervention. These studies have given positive results for regulators: they have also assisted in communication with patients.
The future
For the future the outlook for increased numbers and range of employment for pharmacoeconomists seems good. There seems little prospect of any reduction in regulation or lowering of the fourth hurdle. Indeed it is likely that more countries will make cost-effectiveness data a formal requirement and where this is already the case there will be more intensive use of it. There is also likely to be more use of pharmacoeconomics from new groups of patients/consumers and such use will become much more international.
Within companies the effective use of pharmacoeconomics is likely to become even more critical to survival. This will be especially so for larger companies struggling with the loss of patent protection. It will also be important for newer companies seeking to expand their role in world markets. In 10 years pharmacoeconomics has moved a long way from a backroom research activity to a critical area of company growth and even survival. The next five years seem likely to strengthen employment prospects and add to the diversity of roles for economists in pharmaceuticals.
This is an excerpt from Careers With The Pharmaceutical Industry, second edition, edited by Peter D Stonier and published by Wiley (March 2003). ISBN: 0 470 84328 4. Price £27.50. To order a copy of the book e-mail cs-books@wiley.co.uk or visit www.wileyeurope.com
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