Summary
The most important challenge facing physicians today is the dilemma of providing high quality care in a fiscally responsible fashion. Cost can no longer be ignored. Pharmacoeconomics is a fundamental component of medical education. Economic issues should be an integral part of the drug development and clinical trials. While anaesthetists are concerned that the use of less expensive drugs may compromise patient outcome and satisfaction there is little evidence to support such concerns. This is a fertile area for intense future research.
Pharmacoeconomics is a dynamic. The cost of drugs is not static, patterns of drug use shift rapidly and clinical practice is in a state of constant change. The answer to cost containment is not simply to cut, cap, delist or merely hope for the best, but rather to manage and modify practice while accommodating changing needs.
Educational programmes, guidelines, department policies, system changes and financial incentives can be implemented to ensure consistent and enduring adherence to the principles of pharmacoeconomics and value based care. Some suggest that national societies should create guidelines for cost-beneficial practice. Others favour physician autonomy in drug selection. Changing physician behaviour is difficult. This change will occur gradually and will be the topic of many emotionally charged philosophical debates. There will be great reluctance to deny patients pharmacologically superior drugs based on cost alone, especially since drugs are such a small portion of the total costs. We must exercise caution to ensure that we don’t become penny wise and pound foolish. Drug acquisition costs are only one element in a large and complex equation. Concentrating on acquisition drug cost may be dangerous, even naive if we fall prey to knowing the cost of everything but the value of nothing.
Résumé
De nos jours, le défi le plus important auquel doit faire face le médecin est la dispensation de soins de haute qualité d’une manière économiquement responsable. Les coûts ne peuvent plus être ignorés. La pharmacoéconomie est un sujet fondamental de l’éducation médicale. Les questions économiques devraient être une composante intégrale du développement des médicaments et des essais cliniques. Même si les anesthésistes sont préoccupés par le fait que l’utilisation de médicaments moins coûteux puisse compromettre le devenir et la satisfaction des patients, il y a peu de données qui supportent de telles préoccupations. Voilà un champ de recherches futures très fertile.
La pharmacoéconomie est une science dynamique. Le coût des médicaments n’est pas statique, les modalités d’utilisation des médicaments changent rapidement et la pratique clinique est en évolution constante. La réponse au contrôle des coûts n’est pas tout simplement de couper, de plafonner, d’exclure ou simplement d’espérer pour le mieux, mais bien de gérer et de modifier la pratique tout en accomodant des besoins changeants.
Des programmes éducatifs, des lignes de conduite, des politiques départementales, des changements de systèmes et des motivations financières peuvent être mis en application pour assurer une adhésion solide et durable aux principes de pharmacoéconomie et de soins en tenant compte des coûts. Certains ont suggéré que les sociétés nationales devraient créer des lignes de conduite pour une pratique tenant compte des aspects coûts-bénéfices. D’autres favorisent la liberté du médecin dans le choix des médicaments. Il est difficile de modifier le comportement du médecin. Ce changement va se faire graduellement et sera le sujet de plusieurs débats philosophiques émotivement très chargés. Il y aura beaucoup de réticence à priver les patients de médicaments supérieurs au point de vue pharmacologique seulement à cause de leurs coûts, surtout que les médicaments ne représentent qu’une très faible partie des coûts totaux. Nous devons faire attention pour ne pas consacrer notre énergie à des économies de bout de chandelle. Les coûts d’achats des médicaments ne sont qu’un élément d’une équation vaste et complexe. Se concentrer sur les coûts d’acquisition des médicaments peut être dangereux, naïf même, si nous succombons au paradoxe de connaître le prix de tout mais la valeur de rien du tout.
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Stockall, C.A. New drugs in anaesthesia: can we afford them?. Can J Anaesth 45 (Suppl 1), R95–R105 (1998). https://doi.org/10.1007/BF03019211
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DOI: https://doi.org/10.1007/BF03019211