Category: Professional Posters
Purpose: In response to unsustainable increases in drug pricing over the past decade, the inclusion of economic evaluation has emerged as a means of identifying the value of drug therapies. The purpose of this project is to provide a case study showing the novel process of integrating economic evaluation into formulary decision-making at an academic medical center.
Methods: In October 2016, Yale New Haven Hospital, an academic medical center, began development of an evidence-based pharmacoeconomics program to guide the provision of high value care from a cost-effective perspective. Cost-effectiveness analysis is a widely accepted and applied methodology for comparing costs and effects of drug therapy interventions. While the importance of pharmacoeconomic analysis in formulary decision-making has been discussed previously, there are few examples of its integration into practice. The goal of the pharmacoeconomics program was to operationalize the incorporation of pharmacoeconomics into formulary decision-making by developing a systematic and evidence-based process for evaluation, and a standardized method of presentation within the traditional drug monograph. We describe here the steps taken to create a structure that supports pharmacoeconomic inclusion in formulary decision-making, and illustrate the economic evaluation process using a pilot drug, betrixaban. The pilot drug chosen was selected to demonstrate that the incorporation of pharmacoeconomic evaluation is effective for both high cost and high utilization drug therapies.
Results: Yale New Haven Hospital reviewed betrixaban as part of a review of anticoagulation drugs indicated for prophylaxis of venous thromboembolism. A decision analysis was developed to evaluate whether betrixaban was cost-effective when compared to subcuntaneous enoxaparin or heparin for prophylaxis of venous thromboembolism in a hospitalized acute medically ill adult population. The analysis was conducted from a hospital perspective over a one year time horizon. The analysis results were incorporated into the traditional formulary drug monograph and presented to key stakeholders. Initial feedback has been positive, and a preliminary recommendation made regarding the addition of betrixaban to the health system formulary. A final decision is pending. Widespread implementation of the pharmacoeconomics program will require education and buy-in from key stakeholder groups. As familiarity of the pharmacoeconomic perspective increases among clinicians, economic evaluation can be expanded across the health system to target drug therapies in different disease areas. Through this expansion, additional improvements can be made to the review process to increase the applicability of pharmacoeconomic evaluation in day-to-day decision-making.
Conclusion: Pharmacoeconomic evaluation is a useful tool for formulary decision-making as a means of incorporating a more comprehensive assessment of the value of a drug. To our knowledge, no other institutions have incorporated a comprehensive pharmacoeconomic perspective in formulary decision-making. Clinical pharmacists, in collaboration with other stakeholders across Yale New Haven Health System, play a crucial role in the addition of pharmacoeconomic analysis to enhance the current formulary management process. Successful and sustained implementation of the pharmacoeconomic program requires education, oversight, guidance and buy-in from key stakeholder groups across the health system.