[Economic feasibility study and reimbursement rules--illustrated by a concrete example].
BACKGROUND
In deciding whether a pharmaceutical drug should be granted reimbursement, economic considerations play a considerable role. However, the fact that the very decision on reimbursement - whether individual, conditional or general--influences the cost-effectiveness of the drug considered as a medical intervention is often overlooked.


METHODS
In the computation of cost-effectiveness not only purely medical effects should be taken into consideration but also the risk that a patient in need of treatment is not treated--possibly as a consequence of the procedure involved in applying for individual reimbursement--as well as the risk of wasting resources on treatment that is not medically justified. The method is illustrated by a concrete example based on the data from treatment of coronary heart disease patients with statins in the period 1994-1998 where reimbursement was given on an individual basis and after 1998 when conditional reimbursement was introduced.


RESULTS
The individually-based regime turns out to have been very cost-ineffective, given that it prevented medically appropriate treatment of a large number of patients. A simple calculation along the principles outlined here would have shown this resource-loss.


CONCLUSIONS
Including the reimbursement regime in the assessment of cost-effectiveness seems to be a useful tool for preventing the loss of patients who could have been treated at a lower cost with the medical intervention considered than with other interventions currently used in the health care sector.
Keiding
Hans
H
Økonomisk Institut, og Arhus Universitetshospital, Arhus Sygehus, Medicinsk Kardiologisk Afdeling A. Hans.Keiding@econ.ku.dk
Faergeman
Ole
O
D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000191:economics; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005240:Feasibility Studies; D006801:Humans; D004364:Pharmaceutical Preparations / Q000191:economics*; D012051:Reimbursement Mechanisms
D000924:Anticholesteremic Agents; D004364:Pharmaceutical Preparations