Background of ProPEPS
Health care consumers and payers are reacting to the escalating costs of health care. They are demanding lower costs, and higher quality care delivered more efficiently. The School of Pharmacy at UCSF is responding to the challenge by establishing the Program for Pharmaceutical Economics and Policy Studies within the Department of Clinical Pharmacy. ProPEPS was established to meet the needs of patients, caregivers, health care systems, and industry to determine the best use of pharmaceutical care resources in the management of disease in the current health care environment of scarce resources. The Program is research and teaching focused and will concentrate both on theoretically based economics research and health care system based clinical outcomes research. Economic research impacting pharmaceutical health policy, new technology, and outcomes of clinical practice will be major goals of the research program.

ProPEPS is based in the School of Pharmacy, Department of Clinical Pharmacy at UCSF with a core faculty with expertise in clinical, social science, and economic research, but will collaborate with faculty and departments representing epidemiology, economics, medicine, social science, biomedical informatics and statistics available throughout the UCSF and UC Berkeley campuses on a project specific basis. The Program will act to advance the field of pharmaceutical economics through education and development of methodology, application to clinical practice, and social policy.

The goal of ProPEPS is to determine the best use of pharmaceutical resources in the care of patients within current health care systems using techniques of cost-effectiveness, cost utility, cost of illness, decision analysis, modeling, meta-analysis, evidence based medicine and variation management. The Program will be a resource to industry, managed care systems, pharmacy benefits management systems, practitioners, and politicians who must make decisions about the best use of health care resources in patient care.

Specific Objectives:

1. To develop methods in the areas of economic study design, methodology, database development, analysis and interpretation for pharmaceutical economic and drug policy studies including cost and utility assessments, cross design synthesis, meta-analysis, and decision analyses
2. To serve as a bridge in bringing together the Program's and other UCSF researchers with researchers and managers from the pharmaceutical industry, and managed care systems to provide evidence for decisions about the efficient use of pharmaceutical resources
3. To evaluate the cost effectiveness and cost utility of new technologies introduced into the health care system, including new drug or diagnostic products and practices
4. To assess the variations in the pharmaceutical management of patients and their drug treatments in today's health care systems, and to determine the effect of pharmacy treatment strategies on patient outcomes
5. To further graduate education through involvement of fellows and graduate students in the Program and its research resulting in an educated labor pool in pharmaceutical economics and health policy
6. To study the access, costs, and quality of the pharmaceutical care in society.
7. To disseminate theoretical and practical information to the health care community

Unique Aspects of ProPEPS: ProPEPS will provide research to meet the needs of the pharmaceutical industry, managed care systems, and policy officials. This Program will provide a unique capability to plan a research program, collect new data or provide retrospective data from local, state and national databases, and to conduct the research in pharmaceutical economics, health systems research, and health policy.

More specifically:

1. The focus of the UCSF Program will be to provide University based clinical and research expertise in pharmaceutical economics and policy to industries and health care systems who need to make decisions about the organization and use of pharmaceutical technologies and resources.
2. The Program will bring together University-based research methods to address the practical decisions of managed care systems and PBMs in the use of drugs and practice of pharmacy.
3. The Program will bring together University-based research methods to address the immediate policy questions of access, cost and quality of patient drug use and organization for state and national public officials.
4. The Program will bring together University-based research methods to address questions about the cost, utility, and efficiency of the development of new drugs, especially biotechnology drugs, and their introduction into health care systems.
5. The Program will have a core of researchers to evaluate and suggest a program of research and will invite additional UCSF clinical and methodological experts to join the specific project, in order to provide an efficient research proposal with the best expertise.
6. The Program has special expertise in meta-analysis, modeling and decision analysis, cost of illness, placing economics into clinical trials, outcomes analysis, and cost-effectiveness and cost utility analyses, and evaluation of clinical drug study design.
7. The Program has access to several national and state databases to provide information for modeling utilization and costs of care.
8. The Program has individuals with industry and managed care experience to provide practical advice on a program of research for the customer.
9. The Program has access to graduate students, interns, and fellows who will be involved in the research program.

Who can use ProPEPS?
Pharmaceutical Industry: ProPEPS has expertise in developing and conducting research to demonstrate the incremental value of a new product. This program begins early in drug development with a cost of illness study to determine the disease prevalence and mortality and the baseline costs of treating a disease currently. It may be desirable to add some economic and quality of life or utility measures to a phase three clinical trial so that an economic assessment can be made at the time of drug approval. Alternatively, the disease and its treatment may be modeled so that efficacy results from the clinical trial and other published literature can be applied through meta-analysis to the analysis of the cost effectiveness of a new treatment. It may be desirable to focus on the quality of life or patient preferences through utility measurement for a product, which emphasizes these aspects. Finally, it is often important to determine the cost effectiveness of a drug product within a particular health care system through targeted analysis of variations and impacts of treatments within a disease area and the effect a new product introduction will have on the system. ProPEPS can discuss a program of research with you and determine which is best for you.

Managed Care Systems: ProPEPS has expertise in the pharmaceutical care of patients and the selection of the best drug products for a given patient group balancing the cost and quality of each drug by the characteristics of the patient. In addition, ProPEPS has expertise in the management of pharmaceutical care within a managed care system. Our pharmacists are currently practicing pharmaceutical care in a variety of managed care systems and large retail pharmacy systems. We are in a unique position to be able to determine the variations in the use of drug products within a disease area, recommend changes, which emphasize value yet, provide safe and effective drug therapy. We can then provide information on the effects of changes in drug products or additions in pharmacy management of patients, on patient outcomes.

Policy Experts: As the health care system changes and more Medicare and Medicaid patients are entering managed care systems for their health care, it is important to assess the impact on patients' access, cost and quality of care. ProPEPS can examine the effects of these and other policy changes on the health outcomes of patients both on a system by system basis and on a global or more national level. Certain health care problems involve a high level of pharmaceutical care, and many of these are vulnerable to hospital admissions if drug treatment fails either through compliance problems or inadequate treatment. These diseases are excellent candidates for the assessment of variations in practice and outcomes of treatment. ProPEPS can assess the policy impact on these and other disease areas.

Program Directors:

• Leslie Wilson, Ph.D.
• Clifton Louie, D.P.A.

Core Faculty:

• Lisa Bero, Ph.D.
• Patrick Finley, Pharm.D.
• Joseph Guglielmo, Pharm.D.
• Mary Anne Koda-Kimble, Pharm.D.
• Helene Lipton, Ph.D.
• Clifton Louie, D.P.A.
• Leslie Wilson, Ph.D.

Other University Resources at UCSF:

• Institute for Health Policy Studies
• Institute for Health and Aging
• Department of Social and Behavioral Sciences
• Langley Porter Psychiatric Institute
• Cancer Research Institute
• Moffit Long, Mount Zion, and San Francisco General Hospitals
• Other University of California Pharmacy Schools and their affiliated hospitals.

For more information call: Leslie Wilson (415)-502-5092 or Clifton Louie (415) 476-6312
e-mail: wilsonl@pharmacy.ucsf.edu or louiec@pharmacy.ucsf.edu.