Academic journal article American Journal of Pharmaceutical Education

A Pharmacoeconomics and Formulary Management Collaborative Project to Teach Decision Analysis Principles

Academic journal article American Journal of Pharmaceutical Education

A Pharmacoeconomics and Formulary Management Collaborative Project to Teach Decision Analysis Principles

Article excerpt


Effective formulary management is necessary because of finite health care resources. (1) Measuring the value of competing treatment strategies or medications is a complex process. Decision analysis is a method for modeling this complexity and quantifying outcomes so that evidence-based, rational decisions can be made. (2) This methodology is used widely in public health as decision analysis allows comparison of costs and expected gains of 2 competing health interventions. (3) When the health interventions are medications, it is easy to identify the cost-effective choice by determining which drug is more effective and less costly than its competitor. It is much more challenging, however, to identify cost-effective therapy when a medication is more effective but also more costly. This is typically the case with branded medications that enter the market. With decision analysis, data from multiple sources can be pooled and synthesized to determine an answer to whether a newly approved medication is cost-effective compared to its competitor. (5) Researchers quantify probabilities of specific events and outcomes, ie, adverse events, clinical cure, as well as costs associated with these. Doing so allows a mathematical model to be created representing the overall value associated with each option, which can be used to determine the best of course action. (5) With the current emphasis on rational, evidence-based decision-making in health care and the existence of limited resources, cost-effectiveness analyses based upon decision analyses are becoming more common.

Understanding methods for determining the value of medication therapies is vital to pharmacists as they increasingly assume leadership roles in formulary management and resource allocation. (4) Therefore, these concepts should be included in the pharmacy curriculum. To address this gap in the curriculum, a decision was made to add a collaborative decision analysis project to an existing course at the University of Cincinnati James L. Winkle College of Pharmacy. The decision analysis project was implemented to expose students to the process of evaluating the total value of a drug rather than just direct medication costs, and to teach them how this process impacts decision making in formulary management. These topics are taught over 3 courses. Foundational concepts on the role of pharmacy and therapeutics (P&T) committees and the role of pharmacists in development of formularies are taught in the second year in Health Systems Pharmacy Practice (HSPP). Application of these concepts occurs in Pharmacy Practice Skills Development, which is a series of performance-based courses. A Formulary Management Module was added to this course to augment information provided in HSPP. Lastly, more advanced topics, such as decision analysis, are taught in the Pharmacoeconomics course.

In 2008, a collaborative decision-analysis project was implemented in the Pharmacoeconomics course and Formulary Management Module of the Pharmacy Practice Skills Development course. The purpose of the decision analysis project was to help students understand the relevance of pharmacoeconomics to clinical pharmacy practice, and provide an opportunity for students to apply skills taught in the Pharmacoeconomics course to a "real world" problem. This joint-course collaborative project was intended to help students achieve Accreditation Council for Pharmacy Education (ACPE) standards (Table 1), (6) as well as specific terminal outcomes of the Winkle College of Pharmacy PharmD program (Table 2).


In 2002, a practical application module related to the formulary approval process was developed to provide an opportunity for students to apply what they had learned about formulary management in the HSPP course. The Formulary Management Module was designed for each small group (approximately 6 students per group) to evaluate and compare a new drug that had been requested to be added to the formulary with a drug currently on the formulary. …

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