The Pharmacoeconomics of Managing Acute Agitation in the Emergency Department

What Do We Know and How Do We Approach It?

Esther W Chan; David McD Taylor; Jonathan C Knott; Danny Liew; David CM Kong


Expert Rev Pharmacoeconomics Outcomes Res. 2012;12(5):589-595. 

In This Article


Different decision makers in healthcare have different perspectives, including those of the patient, the healthcare institution (i.e., service provider or hospital) and society.[26] The perspective of the hospital is distinct from that of the payer, including a managed care organization. The perspective of the pharmacoeconomic analysis impacts on both the study methods and modeling, hence the perspective of the study should be justifiable and relevant.

Improvement in health condition and QoL is considered from the patient's perspective while the perspective of the healthcare institution (i.e., hospital) is more often concerned with optimizing the health of the patient at the least cost.[26]

The societal perspective considers the improvement in the patient's QOL, minimization of costs and the health budget for the health of the population.[26] Of all perspectives, it is the most comprehensive and broad. However, it is likely to be less appropriate for conditions involving a short duration of treatment, such as the management of acute agitation in the ED setting. Along with direct medical costs (i.e., the immediate costs resulting from treatment or therapy[26]), the societal perspective considers indirect costs relating to the loss of productivity (i.e., inability to work, money for days spent in hospital and early retirement[26,28,34]). Other indirect costs, including time and travel expenses and costs associated with other concomitant illness or nonhealth social services,[27] may also be included in the pharmacoeconomic analysis.

The perspective of the healthcare institution considers the range of costs relevant to the institution. With respect to the management of acute agitation, indirect costs are of lesser relevance when compared to direct medical costs. The Pharmaceutical Benefits Advisory Committee (PBAC) of Australia does not consider indirect costs in its analyses of the outcomes of clinical trials.[103] Similarly, measurements of intangible costs such as those related to physical or psychological well-being are generally not considered useful for the PBAC in its recommendations regarding listing of drugs on the Pharmaceutical Benefits Scheme.