The use of health economics by hospital pharmacist decision makers - A survey of UK chief pharmacists

AIM : To ascertain whether the results of economic evaluations of medicines were used in practice. DESIGN : An anonymous postal structured questionnaire with quantitative analysis of the data. SUBJECTS AND SETTING : Directors of pharmacy in 388 NHS hospitals during 1995. OUTCOME MEASURES : The extent and range of drug and therapeutics committees and formularies, the extent to which health economics is used in formulary decision making, the sources of information on costs and outcomes, and barriers to the use of economic evaluations. RESULTS : Most respondents had a formulary and a DTC in place. The level of formalised training in health economics was low as was awareness of any national guidelines for economic evaluation of medicines. Drug acquisition cost was the most important economic factor in formulary listing but many respondents were prepared to have a better outcome to balance higher drug cost. CONCLUSIONS : There is a low use of economic evaluation of medicines by senior pharmacy managers. The biggest obstacle in the better use of cost-effectiveness studies was the inability to move resources, particularly between primary and secondary care. There was a perception that economic evaluations and information produced by the pharmaceutical industry appeared to be biased and unhelpful in the assessment of new medicines. It is clear that is does not matter what economic evaluations are undertaken if there are not the mechanisms or motivations in place to use the results. Formalised education and raising of awareness in health economic evaluation for NHS decision makers might begin to facilitate this process.