Pharmacoeconomic methods influence only 13% of hospital formulary system decisions: Survey

Pharmacoeconomic methods rank low as a decision influencer on formulary changes, according to a new survey released today by the Society of Hospital Medicine (SHM) and the American Society of Health-System Pharmacists (ASHP). Respondents reported that only 13 percent of formulary system decisions made by Pharmacy and Therapeutics (P&T) committees in hospitals is influenced by pharmacoeconomic methods.

The findings in the new report are based on a survey of 319 ASHP members that were either directors of pharmacy or members of ASHP's Pharmacy Practice Managers Section.

Pharmacoeconomic methods evaluate the value of effects compared to the cost of pharmaceutical products when making decisions on changes to the formulary system. Hospital formularies identify medications and medication-use policies used within a particular hospital. Decisions on the management of a formulary system have a significant impact on the quality and safety of patient care.

"Pharmacoeconomics is all about balancing the costs of medications with the outcomes they provide and this survey pointed out that many P&T Committees underutilize this approach," said SHM Chief Executive Officer, Laurence Wellikson. "Just like the collaboration between SHM and ASHP in conducting and analyzing this survey, we expect hospitalists and pharmacists to work together to provide the safest, most effective medications for our hospitalized patients."

In the study, 87 percent of respondents felt that pharamacoeconomic methods should be used when considering additions or deletions to their hospital formulary. However, when making formulary decisions, respondents reported that clinical and therapeutic factors contribute most to these decisions (54 percent), followed by drug costs (24 percent), pharmacoeconomic methods (13 percent), and patient quality of life (9 percent).

Although, more than nine out of ten survey respondents (93 percent) reported having pharmacoeconomic analysis available during their most recent P&T committee discussion, only 26 percent rated the available information as extremely helpful and 71 percent desired additional pharmacoeconomic information. Barriers to the use of pharmacoeconomic analysis include a lack of understanding of these methods, a lack of pharmacoeconomic information available for use by the committee, and lack of staff resources to compile pharmaeconomic information.

"Pharmacoeconomic analyses are essential to efforts to improve patient outcomes while minimizing costs," said Henri R. Manasse, Jr., Ph.D., Sc.D., executive vice president and chief executive officer of ASHP. "The survey demonstrates that clinicians recognize the importance of these tools, but also identifies barriers to their use. For next steps, we plan to assist our respective members with addressing those barriers."

As both hospitalists and pharmacists take on leadership roles in quality of care and patient safety initiatives, many are now serving on important hospital committees, such as P&T committees that serve as the communication link between the pharmacy and medical staff. As part of the SHM- ASHP joint survey, 60 percent of respondents indicated a hospitalist serves on their P&T committee and 81 percent of respondents indicated a hospitalist works in their hospital. More information on the role of the P&T committee is available in the ASHP Guidelines on Pharmacy and Therapeutics Committee and the Formulary System.

ASHP and SHM share interest in jointly optimizing the care of patients in hospitals and promoting the use of pharmacoeconomic methods in making decisions on hospital's formulary systems.