Role of pharmacoeconomics in formulary decision-making

Abstract

a??Formulariesa?? represent a compendium of pharmaceutical products and services selected by the medical staff of an institution to reflect current drug preferences of healthcare practitioners and patients.Successful formularies restrict access to or discourage the use of those drugs for which there are lower a?? cost substitutes available, thereby encouraging the use of more efficient medications.When compiling and revising formularies, the most frequently used criteria for selecting among alternative drugs are clinical efficacy, risk of adverse effects and daily cost of drug.Too often, such selection processes focus on a search for the least costly alternative, without an explicit analysis of overall cost-effectiveness.For an institution or organization assessing drug costs however, the more relevant issue is, how much a drug therapy costs in the context of overall patient care for a given disease. As such a reassessment of the role of the formulary and the manner of its implementation is taking place. The purpose of todaya??s formulary is to promote the efficient use of drugs.The importance of pharmacoeconomics in formulary decision-making lies in the information provided about the value and efficiency of alternative pharmaceutical products compared withother relevant treatment alternatives when both costs and consequences are considered simultaneously.However if Pharmacoeconomics is to contribute to formulary decision-making P & T Committees must appreciate the potential role of that discipline in such decisions; at the same time, pharmacoeconomists must demonstrate that their analyses can lead to more efficient allocation of limited resources in the purchase of drugs without compromising the quality of healthcare.Initial exploratory surveys of pharmacists in Singapore clearly established the need and scope for use of pharmacoeconomics in hospital settings in the country.Contending that pharmacoeconomics has a definite role in formulary decisions the researcher endeavored to test this hypothesis in the setting of the university hospital through a means deemed appropriate by her. This was to evaluate one or two products for each P&T Committee meeting through 3-4 meetings and submit the evaluations for facilitating P&T Committee decision-making.An objective measure of the success of the process would be an assessment of the percentage change in the number of P&T approvals and potential cost savings to the organization as a result of pharmacoeconomic assessments. However, due to the inherent nature of the project and a lack of time it was not possible to consider them as primary outcome measures.Economic evaluations (as proposed and demonstrated by the researcher), in addition to the primarily pharmacotherapeutic (efficacy and safety) based considerations currently taken into account by the P&T Committee at the NUH would entail a more comprehensive or in-depth evaluation of formulary actions (addition or deletion) leading to increased user satisfaction.Hence, the primary outcome measure was taken to be user satisfaction to be measured or gauged by a questionnaire at the end of 3 or 4 P&T committee meetings.The responses clearly revealed that a majority of the decision-makers expressed satisfaction with the researchera??s approach to formulary decision-making and would even be willing to consider a health economist as a member of the committee.Therefore, the researcher was successful in demonstrating to the relevant decisionmakers the role of pharmacoeconomics in formulary decision-making.