The role of pharmacoeconomics in formulary decision-making Aug 1, 2006 By: Emily Walkom, PhD, Jane Robertson, PhD, David Newby, PhD, Thamizhanban Pillay, PhD

The role of cost- and pharmacoeconomic-related criteria in formulary decision-making was assessed in a literature review of 31 studies of hospital (n=18) and managed care (n=13) pharmacy and therapeutics (P&T) committees. In both settings, cost was important, although the elements of cost considered varied. Acquisition cost was mentioned more frequently than pharmacoeconomic or cost-effectiveness information. Other factors, including drug characteristics, quality of life, supply-related issues, and physician demand, also influenced decisions.

Objective: Pharmacy-managed medication assistance programs (MAP) have the potential to recoup losses incurred by the pharmacy department, but whether this offsets the personnel cost of the program has not been well-established. The purpose of this study was to conduct a cost-benefit analysis of the pharmacy-managed MAP at an urban teaching clinic at Hartford Hospital in Hartford, Conn.

Effective decision-making in benefit management requires an understanding of the economic burden of an illness - in this case, the economic burden and treatment of alcoholism. This article provides an understanding of the true costs of the disease, what has been found to be effective in its treatment, and what treatments may lessen the economic burden of the disease.

Seldom are the attributes of drugs under formulary consideration conveniently measured on the same scale, and if they are, they typically do not carry the same weight in a decision. Fortunately, application of Multiattribute Utility Technology (MAUT) provides a way to incorporate several valued attributes of disparate weights into a unitary measure for the purpose of evaluating options. This month's column presents the core elements of MAUT and explores its use in the drug evaluation process through a mock formulary committee example.

Although sensitivity analysis is a widely used technique for testing the uncertainty in pharmacoeconomic modeling parameters, it does have limitations. This month's column introduces probabilistic sensitivity analysis as an alternative method for examining uncertainty.