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.

Cost-effectiveness of 4 empiric antimicrobial regimens in patients with community-acquired pneumonia Sep 1, 2005 By: Christopher R. Frei, PharmD, MS, BCPS, David S. Burgess, PharmD, FCCP

This study compares the cost-effectiveness of the 4 most common empiric antimicrobial regimens used for the treatment of adults with community-acquired pneumonia (CAP) at a community health system during a 6-month period. Associations between initial antimicrobials and total hospital costs were determined. Cost-effectiveness ratios were determined by dividing the total hospital costs by the percent survival. A total of 415 patients met criteria for the Pneumonia Severity Index (PSI) risk class IV or V. Costs (adjusted for inflation) were as follows (median, 25th and 75th percentile): total hospital costs ($5,078 [$3,218–$8,144]), pharmacy costs ($753 [$455–$1,357]), and antibiotic costs ($139 [$82–$229]). The most favorable cost-effectiveness ratio was observed for patients who received levofloxacin monotherapy ($4,635 per life saved), followed by ceftriaxone plus a macrolide ($5,278), ceftriaxone monotherapy ($5,368), and ceftriaxone plus levofloxacin ($6,317).

Cyclooxygenase-2 selective inhibitiors, better known as coxibs, may not be cost-effective for treatment of chronic arthritis pain in patients at average risk for ulcer complications as compared with nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), according to a study recently published in the Annals of Internal Medicine. Using a coxib versus a NSAID cost an incremental $275,809 per year to gain 1 additional quality-adjusted life-year (QALY). For patients with a history of bleeding ulcers, however, the incremental cost per QALY gained decreased to $55,803.

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.