Hospitals want pharmacoeconomics data, but lack it

Need is there; execution is missing

The American Society of Health-System Pharmacists (ASHP) and the Society of Hospital Medicine (SHM) jointly surveyed health care systems about their use of pharmacoeconomics data in drug formulary decisions and other activities.

"We wanted to see what the state of art is in how people are using pharmacoeconomic assessments in the formulary management process," says Cynthia Reilly, RPh, director of the practice development division of ASHP in Bethesda, MD.

"The survey has identified areas where new tools are needed," she says. "People definitely think there's a lot of value to pharmacoeconomic assessment in formulary decision-making."

But the survey also found that the different types of analysis are not used the way they should be, she adds.

Here are some of the survey's other findings:

  • Hospital pharmaceutical and therapeutics (P&T) committees use pharmacoeconomics, the balance of costs and outcomes, for only about 13.2% of their decision on formulary changes. Clinical and therapeutics factors, by contrast, account for 53.6% of the decision-making process, and drug costs alone are factored in 24.3% of the decision. Academic medical centers emphasized clinical factors more than other types of hospitals, the survey found.1
  • While 86.8% of respondents say they believe pharmacoeconomic methods should be used most of the time when changing hospital formularies, only 59.4% of respondents said they do use pharmacoeconomic methods most of the time.1
  • Three-quarters of respondents said these classes of medications benefit from having pharmacoeconomic analysis available during P&T committee discussions: antibiotics, anticoagulants/low molecular weight heparins, proton pump inhibitors, and antifungals.1
  • Most survey respondents (93%) reported using a pharmacoeconomic analysis during their most recent P&T committee discussion, but this was most commonly a cost analysis, rather than the more useful methods of cost-effectiveness analysis, cost-benefit analysis, and sensitivity analysis.1
  • Close to half of respondents said they'd like to use a pharmacoeconomics analysis that balanced costs and outcomes, and one-quarter of these respondents said they'd like a tool that could use hospital-specific costs in the model.1
  • About 26% of respondents rated pharmacoeconomic information as extremely helpful in decision making, while most respondents found the information as at least somewhat helpful.1

"A lot of hospitals will look at the direct cost of buying the drug, stocking the product, and think that's their complete pharmacoeconomic assessment," Reilly says. "But there are indirect costs included in other types of analyses, such as the drug's effectiveness in reducing readmissions or getting better patient outcomes."

Advanced pharmacoeconomics will dive into these real issues, she adds.

"Why not do pharmacoeconomic assessments as part of the budgeting process?" Reilly suggests. "I think right now people are looking at the most basic analysis, predominantly at the cost of the drug, and also, most recently, we're looking at nursing time to administer, as well."

But the latest thought is to determine whether patients will be readmitted and other deeper pharmacoeconomic issues.

"It's almost like an onion-layering effect, and we're moving away from a fully direct drug cost and have been for a while," Reilly notes.

The challenge is that most hospital pharmacists lack the pharmacoeconomic assessment tools necessary to provide in-depth analyses. And they often lack the necessary skills.

"You need to have literature assessment skills and have a good understanding of the different types of skills available," Reilly says.

"One thing we're looking to do is develop a primer on the different types of assessment," she adds. "For instance, there is a cost-minimization analysis, which is a starting point for many people."

The literature is available, but pharmacists need to know how to apply it and find the true value of pharmacoeconomics, she notes.

"This largely is done through the pharmacy and therapeutics committee," Reilly says.

Other resources include ASHP's published articles on pharmacoeconomic analyses, including literature on an assessment of different classes of drugs.

"ASHP has guidelines to help people with different formula decision-making processes," Reilly says. "Also, ASHP offers a publication on statistical analysis."

Pharmacists also could find training in statistical analysis in continuing education programs at the local or state level.

"We'll address this topic at our national meeting, as well," Reilly says. "So there now are a variety of sources to get this information."

Reference

  1. Pedersen CA. Report on the Society of Hospital Medicine/American Society of Health-System Pharmacists Joint Pharmacoeconomics Survey, 2010. Available at: www.hospitalmedicine.org.