LEA DI NG ARTICLE

PhannacoEc:onomies 5 (5): 367-375. 1994 117(). 7691YJ4JOOO!i-03671104.WO C A d;s In~mational Limited. All righlS reserved.

Expanding the Role of Pharmacists in Pharmacoeconomics Why and How?

Lisa A. Sanchez

Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts, USA

Rising concerns with escalating healthcare costs have created a unique practice environment for healthcare professionals of the 1990s. This envi­ronment has necessitated the valuation of health­care, especially pharmaceutical products and ser­vices. Today's pharmacists must not only be able to evaluate safety and efficacy of drug therapy, but also incorporate a pharmacoeconomic component. The purpose of this article is 10 illu strate the value of pharmacoeconomics in modem pharmacy prac­tice, motivate pharmacists to expand their current roles to include pharmacoeconomics. and provide strategies for incorporating pharmacoeconomics into traditional pharmacy roles.

1. The Impact of Pharmacoeconomics in the 1990s

The potential impact of pharmacoeconomics on pharmacy practice for the nellt decade and beyond is significant. Globally, many resources are ex­pended on pharmaceutical products , as illustrated in table I (Editorial 1992). Ahhough pharmaceuli­cal products account fo r less than 10% of heahh expenditures in most countries, they still represent a significant cost item (Evans 1992; Health Care Financing Adminislration 1987). With healthcare costs accounting for approximately 13% of the US Gross National Product (GNP) and 7 to 9% of the equivalent in mosl European countries, the demand for information about the benefits and costs of these products and services grows (Editorial l99 la). Ad-

ditionally, as unique pharmaceutical and biotech­nology agents are developed and these costly agents become available, the impact on the heallhcare sys­tem may be vast (Jones-Grizzle & Bootman 1992).

Various strategies have been devised by govern­ments in an attempl to keep the costs of drugs down. These include restricting the profits that pharmaceuti cal companies will make [e.g. the Pharmaceutical Price Regulation Scheme (PPRS) in the UK]; forcing pharmaceutical companies to charge less (e.g. Italy and Japan have considered adopting this approach); and the adoption of na­tional formularies (e.g. in Germany, The Nether­lands, Canada and Australia) [Editorial 199 1bJ. Despite these cost-containment efforts, Ihe cost of pharmaceutical products continues 10 rise.

Given taday's healthcare environment. compe­tition for scarce healthcare resources has necessi-

Tabte I. WOI1ctwida resource utilisation for medjcatiOt1$ In the top 10 therapeutic categol1" (adapted lrom Editorial 1992)

SUS millions ThefaP8l,ltic calegory

9013.6 8903.5

"".1 3S63.' 3116.7

3000.' 2068.' 1379.1

1153.5 1063.3

Anti-infectiva Cardiovascular Antiulcer Ceollal nervous system Respiratory

NOt1steroidal anti-inflammatory drugs Cholesterol-lowering

Anticancer Antiviral Imaging agents

368

lated the justification of pharmaceutical products and services as economicall y sound. Pharmacy de­partments, whose services often consume a large portion of institutional resources, are finding them­selves pressured to assess the value of the products and services they provide, as are other healthcare professionals. This has created a new challenge, dimension, and opportun ity for pharmacy: namely, phannacoeconomics. Pharmacoeconomics, the dis­cipline ofplad ng a value on drug therapy, provides the tools for these assessments.

2. Why Expand the Role of Pharmacists to Include Pharmacoeconomics?

There is an abundance of reasons why pharmaco­economics is critical today. When combined wilh a host of common misconceptions surrounding this discipline. it becomes apparent why it is crucial for pharmacists to expand their current roles to include pharmacoeconomics. A few specific reasons and misconceptions are discussed below.

2.1 Reasons

2.1.1 Determination of the 'Value ' of Pharmaceutical Products and Services A widespread interest in knowing the value of

medici nes is evident in today's healthcare envi­ronment. Many pharmacy departments are being forced to operate with, and compete for, scarce and often diminishing resources. Thus, many pharma­cists are being challenged to provide quality pa­tient care at a minimal cost. With concerns over cost as a common link joining the profession, phar­macoeconomics provides pharmacists with a new opportunity : the ability to quantify the value of the products and services they supply. Pharmaco­economic methods provide the means to place a value on these goods and services.

Valuation of pharmaceuticals can hel p balance cost with patient outcome, choose between com­peting treatment options, and assist in medication use decisions. Furthermore, by quantifying the value of the profession. pharmacists can document and justify their existence to their customers. Addition­ally, pl aci ng a value on pharmaceuticals through

PharmacoEconomics 5 (5) 1994

pharmacoeconomic analyses may increase their acceptance by the medical profession, third party payors, hospital administrators and healthcare con­sumers (McGhan 1993).

For example. when choosing between compet­ing treatment alternatives, applying the appropri­ate pharmacoeconomic method can help. With many treatment options to choose, and many that differ with respect to safety, efficacy and cost, si mply comparing acquisition costs may not actually pro­vide the least expensive alternative. Costs associ­ated with diminished safety and effi cacy profiles must be included in this valuation, which can be difficult or mi sleading without the proper tools to employ. However. comparison of acquisition costs may be appropriate under certain circumstances depending o n the alternati ves compared and the perspective taken.

2.1.2 Balancing Cost and Qualify of Care Given today's cost-sensitive healthcare envi­

ronment, it is imperative that quality patient care is not diminished in the process of containing costs. Using pharmacoeconomic techniques en­ables the pharmacist to balance cost and patient outcome to determine which treatment alternatives yield the best outcome per dollar spent. Addition­ally, conducting pharmacoeconomic analyses can assist in determining which products and services represent the best value for patients, departments and institutions.

2.1.3 lncreased Pharmacist Involvement in the Drug Decision-Making Process Overall. increasing numbers of pharmacists are

becoming involved in institutional medication use decisions. For many pharmacists thi s translates into assessing the costs and conseq uences of var­ious alternatives, and recommending the most cost-effective treatment options to medical deci­sion-makers (Lee & Sanchez 1991 a).

Data necessary to support and justify many of these recommendations and decisions can be sup­plied by pharmacoeconomics. Medication use de­cisions that can benefit from pharmacoeconomics include formulary management, drug use policy,

Role of Phannacisis in Phannacoeconomics

resource allocation and individual patient treat­ment decisions.

Sound drug therapy decis ions s hould contain three components: safety, efficacy and pharmaco­economic value. Above all, drugs must be safe and effective, but to be competitive in today 's health­care environment. they need to demonstrate phannaco­economic value. Pharmacists can assess the safety and efficacy components of clinical decisions, but often lack the skills and experience to assess the pharmacoeconomic aspect of the decision.

For example. when providing assistance for a formulary management decision involving 2 com­petitive agents, a pharmacy practitioner not trained in pharmacoeconomics might simply compare ac­quis ition costs (e.g. cost per tablet), whereas a pharmacist familiar with pharmacoeconomic meth­ods would eval uate the cost per therapeutic out­come. A thorough cost-effectiveness analysis may reveal that a less expensive therapeutic alternative, with a dimini shed safety and efficacy profi le, may have potential costs associated with its use. These could include drug, laboratory and medical person­nel costs o f retreating treatment failures and treat­ing any adverse drug reactions identified with this agent. Through this analysis. the drug therapy which results in the optimal therapeutic outcome worth its total cost could be determined.

Similarly, pharmacoeconomic skills could be usefu l in j ustifying the value of an ex isti ng phar­macy service or the potential worth of a new phar­macy servi ce. Im plementi ng a new therapeutic drug monitoring service, for example. may require justification and documentation of the va lue of thi s service to secure institutional resources (Lee & Sanchez 1991b). A pharmacist without pharmaco­economic skills might weigh the cost of the pro­gramme (e.g. a p harmacist's salary) against the per­ceived benefit (e.g. a decrease in total antibiotic costs). However, a pharmacist with phannacoecono­mic skills would employ cost-benefit analys is to identify and translate into dollars (a) all of the relevant costs incurred by providing the service, and (b) all of the benefi ts reali sed to the institution through implementing the service. The benefits

369

captured through applying this method may extend beyond a decrease in total drug cost and include a valuation of decreased incidence of adverse drug reactions. and decreased length of stay (Destache el al. 1990).

2.2 Common Misconceptions

Currently. there are common misconceptions surrounding pharmacoeconomics. Recognition and clarification of these misconceptions will increase the understanding and acceptance of the benefits of pharmacoeconomics by the pharmacy profes­sion. Fi ve common misconceptions are di scussed here.

2.2.1 'Pharmacoeconomics Equals Cost Effectiveness' Cost effectiveness is only one of several meth­

ods used to place value on drug therapy. Broad types o f pharmacoeconomic assessment include economic evaluations, which include cost-effec­tiveness. cost-minimisation, cost-benefit and cost­utility analyses, and humanistic evaluations, such as assessing patients' quali ty of li fe, preferences and satisfaction.

2.2.2 'Pharmacoeconomics does not Affect P/aamlacy Practitioners' Pharmacoeconomics is a d isci pline that phar-

macists can use in the daily practice of pharmacy, irrespective of practice setting. With the pharma­ci st often referred to as the 'drug expert ', he or she is an ideal healthcare professional to assess the costs and consequences of drug therapy. The

, pOlenti al r ole of the pharmacist in pharmaco­economics is significant, as all pharmacists can benefit from using or performing pharmacoecono­mic research.

2.2.3 'Pharmacoeconomics is a Fad' Given the new responsibilities of pharmacists

as healthcare professionals, it will become increas­ingly crucial to use the tools of pharmacoecon­omics. just as the tools of pharmacokinetics have been developed and deployed. As ou r healthcare environment becomes increasingly cost-conscious,

370

pharmacoeconomics will playa lasting role in pharmacy practice.

2.2.4 'Phannacoeconomics Equals Cost Containment' With increased pressure to decrease drug costs,

many strategies aimed at controlling costs have emerged. Unfortunately, many of these strategies focus only on determining the least expensive al­ternatives while disregarding the impact on patient outcomes. By applying pharmacoeconomic tools like cost-effectiveness analysis, patient outcomes and economic outcomes are both considered.

2.2.5 'Pharmacoeconomics is a Compromise of Clinical Responsibility' Incorporating economics into clinical decisions

does not necessitate a compromise in the quality of healthcare delivered. Through the utilisation of appropriate pharmacoeconomic principles and methods, cost is balanced with quality todetennine which treatment alternatives yield the highest qual­ity per dollar spent. Balancing cost and quality of care can assist the pharmacist in maintaining high quality patient care at a potential cost savings to hislher institution and patients.

3. How to Expand Pharmacy Roles to Include Pharmacoeconomics

Currently, most pharmacists are unfamiliar with pharmacoeconomics and the potential benefits it offers. Despite this, there is an increasing demand for pharmacy practitioners with strong clinical pharmacy skills combined with knowledge of pharmacoeconomic principles and methods. At­taining a basic understanding and appreciation of the value of pharmacoeconomics in the 1990s is critical, and will become an increasingly imponam professional skill to the practising pharmacist as newer, more expensive agents are approved and healthcare costs continue to escalate.

Many pharmacists and departments of phar­macy are being asked to incorporate pharmaco­economics into their practice of the profession. Currently, expansion of traditional roles to include pharmacoeconomics requires a proactive, global

PharmacoEconomics 5 (5) 1994

and profession-wide approach. A keen awareness of the benefits and importance of phannacoecon­omics must be realised to initiate pharmacists to incorporate pharmacoeconomics into their current roles.

There are various means for pharmacists to acquire basic pharmacoeconomic skills, including academic programmes, fellowship and residency programmes, educational materials and various continuing education programmes. The majority of formal training programmes (academic, resi­dency and fellowship programmes) are concen­trated in the US, therefore these programmes are highlighted.

3.1 Academic Programmes

Draugalis and Jones-Grizzle (199 1) stated that, although many subspecialties of pharmacy have and are continuing to emerge, a common link join­ing the profession and affecting the work of every pharmacist is a concern for cost. With such an em­phasis being placed on economics in our society, it seems inevitable that pharmacoeconomics will playa major role in the future. Therefore, including phannacoeconomics into curricula of colleges of pharmacy is cri tical (Draugalis & lones-Grizzle 1991 ).

Few universities offercoursework in pharmaco­economics at either the graduate or undergraduate level. Currently, approximately 7 or 8 colleges of phannacy in the US have developed research cen­tres, institutes for phannacoeconomics, or offer concentrated academic coursework in pharmaco­economics (table II). A similar trend has been noted internationally. Due to the diversity in pro­grammes, there is currently no standardisation of pharmacoeconomic training or cenification.

All phannacy students need exposure to phar­macoeconomics and its potential impact on their future practice of pharmacy. Both graduate- and undergraduate-trained pharmacists can benefit from acquiring pharmacoeconomic skills. Stu­dents awarded undergraduate pharmacy degrees may be pressured to incorporate pharmacoeconom­ics into their practice, regardless of setting (e.g.

Role of Phannacists in Phannacoeconomics

Table n. Some us acaoomic instiMions which cHer training in

pharmacoecor.ornics

Unive"ity 01 Arizona

Unive"ity 01 MisSissippi

Ohio State Unive"ity

Philadelphia College of Phannacy and Sciences University of Southem California

Univelsily of South Carolina

University of Washington

washington State University

retail, hospi tal, home healthcare). Graduate phar­macy students (i.e. masters or doctorate level), may also benefit f rom pharmacoeconomics when prac­ti sing in healthcare institutions. academia or the pharmaceutical industry.

3.2 Fellowship and Residency Training

Thus far. the most productive means o f meeting the emerging need fo r pharmacists with pharmaco­conomic skills have been through pharmaceutical industry-sponsored fellowships. The first indus­try-sponsored fellowship programme was offered by The Upjohn Company. Currentl y, various phar­maceutical companies (e.g. Glaxo Inc ., Eli Lilly, Sandoz) offer programmes in conj unction with some of the academic institutions shown in table II (e.g. Uni versity of Arizona. Universi ty of South Carolina. University of Washington. Phi ladelphia College of Pharmacy and Sciences). The goal of these programmes is to train Doctor of Pharmacy (PharmD) graduates for careers as pharmacoecon­om ic drug researchers. practi tioners and consult­ants in healthcare institutions and the pharmaceu­tical industry.

These programmes a re generall y 2 years in du ration. with the fi rst year spent at a panicu lar academic institution. The fe llow enrols in didactic training aimed at developing economic. research and outcomes assessment skills. During this year, the fellow also develops a fo rmal research pro­posal. The fe llow then r elocates in the second year to the pharmaceutical company's headquarters for research and development Here the fellow works wi th pharmacoeconomic research scienti sts to gain actual research experience. In addition to complet-

371

ing the project proposed in the fi rst year, the re­search experience al so includes work on various pharmacoeconomic projects assigned by the com­pany preceptor.

Additionally, US residency programmes aimed at training pharmacists to apply pharmacoeconom­ics in the hospital sett ing have recently been devel­oped . The 2 programmes developed t o date include programmes at the Brigham and Women's Hospital and New England Medical Center. both in Boston. Massachusetts.

3.3 Published Educational Material s

Various educational primers focused on phar­macoeconomics have been published (Bootman I 993a.b: Coons 1993: Draugalis et a!. 1989: Freund & Dittus 1992: laeschke et a!. 1992; Lee & San­chez 1991 b: McGhan 1993: Sanchez & Lee 199 1). The p urpose of these articles is to provide the reader with an introduction to pharmacoeconomic principles and methods.

Two jou rn als with a specific focus on the dis­cipline of pharmacoeconomics are available and worth mentioning. These include thi s pUblication, Pha rmacoEconomics. which is international in content and readership, and the Journal of Re­search in Pharmaceutical Economics, a US-based publication . Also. various medical and pharmacy j ourna ls reg ularl y publ ish pharmacoecono mic papers and some contain a month ly section de­voted to pharmacoeconomics (e.g. DICP: Annals of Pharmacotherapy and Clinical Therapeutics ).

A tex tbook describing the basic principles and methods of pharmacoeconomics is also available (Bootman et al. 199 1). The purpose of this text is to present techniques, tools and strategies useful for the evaluation of the economic component of drug therapy at the policy level and fo r individual patient needs. Additionally, various textbooks in other disciplines contain chapters devoted to some aspect ofpharmacoeconomics (Boyer & Tow nsend 1991 : Eisenberg et al. 1989) .

Primers. textbooks and journals focu sed on pharmacoeconomics can provide a basic introduc­tion to the principles and methods of pharmaco-

372

economics. However. these malerials shou ld be combined with practical experience or fonnalised training.

3.4 Continuing Education Programmes

Many continuing education programmes focus­ing on pharmacoeconornics are being offered. often in conjunction with professional society meetings. Formal recognition and support of pharmaco­economics as a discipline of pharmacy by the pro­fessional societies of all countries will be instru­mental in expanding pharmacy roles to include a phannacoeconomic component.

More intensive pharmacoeconomic sy mposia with workshop sessions are offered by various US academic institutions (e.g. the University of South­ern California and the University of Ari zona). These programmes can range in depth, methodolog­ical concentration and focus of application. Over­all, these programmes can be helpful in learning the basic principles and methods of pharmaco­economics and how to apply pharmacoeconomics to various healthcare settings. However, it is im­portant to note that most of these programmes provide a thorough introduction to the basics of pharmacoeconomics, but again should be com­bined with practical application, following pub­lished guidelines.

4. Strategies to Initiate Pharmacoeconomics into Practice

Increased pressure to quantify the value of phar­macy products and services may involve the im­mediate expansion of current phannacy practice roles to include a pharmacoeconomic component. Curremly, it is not feasible for all pharmacists to enrol in formalised training programmes. Various strategies to initiate phannacoeconomics immedi­ately into the daily practice of pharmacy, regard­less of country, must be considered (table 1II).

4.1 Strategies for the Practitioner

For the practitioner, various strategies are avail­able for the immediate inclusion of pharmaco-

PharmacoECQnomics 5 (5) 1994

Table Ill. Key strategies to initiate pharmacoecooomics into pharmacy practice

Practitioner perspective Appropriately interpret. critique and use pharmaooeconomic results pu~ished in primary pharmacy and medicall~erature

Conduct institution·spec~ic pharmacoeoonomic research

Construct eoonomic models to forecast 1M impact of medication use decisions on the institution

Administrator perspective Create an awareness of cost in the healthcare institution

Incorporate pharmacoeconomics into the departmental mission

Mandate pharmacoeconomic data Irom pharmaceutical companies

Use cost<Or1tainment strategies to provide a pharmaco­eoonomic impetus

economics into existing pharmacy roles. To incor­porate phannacoeconomics today, practitioners can either use the results of published pharmacoecono­mic evaluations or conduct their own evaluations. Regardless of the route chosen, the practitioner must be familiar with specific methodological is­sues that challenge pharmacoeconomic users and investigators. These issues are briefly discussed below.

4.1. / Using Pharmacoeconomic Literature Over the years, various pharmacoeconomic

evaluations, spann ing different therapeutic areas, have been published in the primary medical and pharmacy literature. When available, published phannacoeconomic results can be useful in choos­ing between therapeutic options, supporting medi­cation use decisions and placing a value on drug therapy. However, to appropriately interpret and use these data, the practitioner must be aware of key phannacoeconomic methodological concerns.

Previously published pharmacoeconomic eval­uations are often sophisticated. and the data diffi­cu lt to interpret and use without a basic knowledge of pharmacoeconomics. To evaluate the worth of economic evaluations, Drummond et al. (1987) de­vised a list of 10 questions that could be posed for every health economic evaluation (table IV). When interpreting, critiquing and using the results from

Role of Pharmacists in Pharmacoeconomics

published pharmacoeconomic analyses. it is recom­mended that the practilioner refer to these and ad­ditional published guidelines (Doubiletet al. 1986; Drummond et al. 1987; Lee & Sanchez 199Ia).

Many claims that specific medical practices or technologies are cost effective fail to provide su f­ficient documentation relevant to the costs and therapeu ti c outcomes of the treatment alterna­tives under study (Doubilet et al. 1986). An eval­uation of the interpretation of cost effectiveness and the sou ndness of the pharmacoeconomic liter­ature revealed that >50% of studies published be­tween 1985 and 1990 and which claimed cost ef­fectiveness, inappropriately interpreted the term (Lee & Sanchez 199Ia). Therefore, when reading published cost-effectiveness evaluations, refer­ence to these citations is recommended.

Additionally, the practitioner is cautioned that some pharmacoeconomic evaluations reported in the literature are conducted in pre marketing clini­cal trials. Economic dala caplUred in this manner can be protocol-driven, and may not represent the economic impact actually incurred in real practice.

Also, it can be difficult to extrapolate the results of a published pharmacoeconomic evaluation to a

Table tV. Criteria for assessing the soundness 01 eoonomic

evaluationa (adapted from Drummond et al. t967)

t . Was a well-<lefined quesboo posed in answerable form?

2. Was a oomPl'ehemiive description 041he competing altematives given?

3. Was thele evidence that the PlO9ramme's ellactiyeness had been established?

4. Were all the important arod retevant costs arod consequences (given the pe!SpICtiYe 01 the sttlCly) 101 each alternatiVe identified?

5. Were costs and consequences measuled accurately in

appropnate physical un~s?

6. Were costs arod consequences vatued eredibly?

7. Were costs arod COOSlque<lClS adjusted lor diIIelential timing?

8. Was an Inclemental analysis of the costs arod consequences at a1tematlves pel1onned?

9. Was a sensHivity analysis pel1ormed?

to. Did !he presentation of study results include allluUlS at coooem 10 i"Qde1$?

J7J

different institutional setting. Since medical prac­tices often differ between institutions, the costs in­curred at one institution may not accurately reflect the costs incurred for the same treatment alterna­tive at another. Overall, misinterpreting published pharmacoeconomic data could have a significant impact on the decisions that affect the overall cost of therapy and the quality of healthcare.

4.1.2 Conducting Pharmacoeconomic Research When insufficient data are available. or if the

results of existing evaluations cannot be extrapo­lated to practice at a particular institution , phar­macoeconomic evaluations must be conducted. Performing pharmacoeconomic evaluations also requires a solid knowledge of pharmacoeconomic methods and principles.

Performing a pharmacoeconomic evaluation incorrectly or applying the wrong method may re­sult in poor decision-making, based on faulty data. Funhermore . the results obtained may be grossly inaccurate or mi srepresent the significance of a problem or the value of a particular option. There­fore, it is imperative that the pharmacist conduct­ing phannacoeconomic evaluations be familiar with the steps and elements necessary for a sound phar­macoeconomic study (Boot man et al. 1991; Drum­mond et al. 1987; Jolicoeur et al. 1992).

Optimally, pharmacoeconomic evaluations should be conducted in a randomised, placebo­controlled, large population design. However, when solvi ng pharmacoeconomic problems in real practice setti ngs, it may not be feasible to conduct evaluations in thi s manner. Forexample , when try­ing to determine which drug to approve for formu­lary inclusion or which agent is the most cost ef­fective for lreating a particular patient, the resources to conduct a scientifically rigorous study may not be available. tn these cases, economic modelling using decision-analysis can assist in forecasting the most cost-effective alternative. Also, a I O-step ap­proach that can streamline the pharmacoeconomic research process. while ensuring key elements of pharmacoeconomic research are present, has been identified by Jolicoeur and colleagues (1992) [ta­ble V]. These steps may provide a framework for

374

conducting pharmacoeconomic evaluations in a timely and more cost-effective manner in a phar­macy practice setting.

4.2 Strategies for the Administrator

Various strategies are available 10 the pharmacy administrator to initiate pharmacoeconomics inla the pharmacy department. These include creating an awareness of cost, incorporating pharmaco­economics into the departmental mission and man­dating relevant pharmacoeconomic data from the pharmaceutical industry.

4.2.1 Creating an Awareness o/Cost Recognising cost as an important part oftoday's

practice of pharmacy is critical. Cost is no longer an unacceptable topic for discussion in healthcare institutions. Furthe rmore, concerns with cost needs to be a part of everyone's job. It is important to realise that including cost in healthcare decisions does not have to have a negative influence on the quality of care.

4.2.2 Incorporating Pharmacoeconomics into the Departmental Mission An integral part oftoday's successful and inno­

vative pharmacy departments is pharmacoecon­omics. Incorporating phannacoeconomics into the mission of a department can emphasise the impor­tant role that pharmacoeconomics plays. Including phannacoeconomic assessments of high cost med-

Table V. Ten·step approach to performing pharmacoeconomi<: researct1 {adapted from Jolicoeur et al. t992)

t. Define the pharmacoooonomi<: problem

2. Determine the study"s perspective

3. Determine the treatment aftematives and outcomes

4. Select the appropriate pIlarmaooeconomi<: method

5. Place monetary values on the outcome

6. Identify resources

7. EstabliSh \I1e probabimies 01 the outcome events

8. Use decision-analysis

9. Discount costs or perform a sensitivity or incremental cost analysis

10. Present the results

PhannacoEconomics 5 (5) /994

ications in the annual departmental goals and ob­jectives, and incorporating pharmacoeconomic re­sponsibilities into e:< isting job descriptions, will illustrate the department 's commitmenl to this dis­cipline. In some institutions, it may become neces­sary to devote a position(s) or di vision of phar­macoeconomics in the department.

4.2.3 Mandating Pharmacoeconomic Data from Pharmaceutical Companies Phannacoeconomic data can be a critical com-

ponent of drug policy and fonnulary decisions. Con­sider requiring phannaceutical companies to sup­ply the appropriate phannacoeconomic data when their agent comes up for fonnulary consideration . For e:<ample, if a new fluoroquinolone is being re­quested for fonnulary inclusion, it is important to ask for comparative cost-effectiveness data.

Data generated by the pharmaceutical industry does not necessitate bias in results reported. By using and applying the guidelines for assessing the soundness of economic evaluations, the worth of the study can be detennined and the results used appropriately. Also, it should be remembered that study perspective, treatment alternatives compared and outcomes under study mayor may not b e rel­evant for specific institutions.

4.2.4 Using Cost Containment to Provide Pharmacoeconomic Impetus Although cost containment strategies are not

synonymous with pharrnacoeconomics, they can provide a stimulus to incorporate phannacoecon­omics into a phannacy department.

For e:<ample. providing drug acquisition costs in pocket formularies distributed to healthcare professiona ls (e.g. physicians and nurses) may de­crease total medication costs for panicular agents. These efforts may not be 'pharmacoeconomically sound ' in that they do not consider both economic and patient outcomes, but when used appropriately

they can make measurable decreases in institu­tional costs.

Role of Pharmacists in Pharmacoeconomics

5. Conclusions

Contemporary pharmacy practice requires a knowledge of phannacoeconomics. Pharmacists, regardless of practice setting, can benefit from pharmacoeconomics because this discipline pro­vides the tools to quantify the value of pharmacy products and services. However, until more fonnal training programmes are avai lable, pharmacists must be proactive in obtaining phannacoeconomic ski lls and initiating pharmacoeconomics into prac­tice. Expanding traditional pharmacy roles to in­clude phannacoeconomics is a responsibility to the pharmacy profession and 10 the heallhcare system. Pharmacoeconomics will play an integral part of the future of heahhcare, and the future is now.

Acknowledgements

1ne author wis.hc:s to acknowledge the assistance and prac­tical upcrtisc of Dr Gene Gibson and the support of the Brigham and Women's Hospital Department of Phannacy Services.

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Correspondence and reprints: Dr lisa A. Sarrc~l.. Manager, Pharmacoeconomics. Depanment of Pharmacy Services, Brigham and Women's Hospital. 75 Francis Street, Boston, MA 02115, USA.