Do economic evaluations have a role in decision-making in Medicine Management Committees? A qualitative study

Abstract

To explore pharmacists' perceptions on the use of economic evaluations in decision-making within Medicine Management Committees (MMCs), identify factors that influence the uptake of economic evidence and examine the usefulness of different presentations of economic evidence. This two-stage qualitative study was carried out in July and August 2004 in two hospitals in northwest England. First, a researcher observed the decision-making process at two MMCs. Handwritten notes were made during observation, which were later transcribed. Subsequently, in-depth semi-structured interviews were conducted with a purposive sample of pharmacists involved in the MMCs. The interviews explored pharmacists' views on the usefulness of economic evaluations in decision-making, the factors influencing the uptake of economic evidence by the MMCs, and the optimal presentation of economic results. The interviews were audiotaped and transcribed verbatim. All the transcribed data were thematically analysed using the constant comparison approach. In all, six new drug applications were observed and ten pharmacists were interviewed. Pharmacists were observed to play an important role in decisions about drug formularies in hospitals. Although interviewees considered that timely economic evaluations would be useful in reviewing new medicines, the actual use of economic evidence in decision-making within MMCs was limited. The barriers to using economic evaluations included pharmacists' lack of initiative to search for and difficulty in understanding economic evaluations, and the perceived availability, credibility and transferability of economic studies. However, the main barrier to implementing economic evidence was the decision makers' concern about the impact of the medicines on the hospitals' drug budgets. Interviewees felt that they understood and trusted disaggregated economic results better than aggregated ones. This study found the use of economic evidence in decision-making at both MMCs was limited. To improve the usefulness of economic evaluations in MMCs, members of MMCs will need more training in accessing, understanding and appraising economic evidence; researchers need to improve the credibility and transferability of economic studies, and present the results in clear and understandable ways. However, due to the restricted focus of local, short-term drug budgets, evidence-based decision-making remains a challenge for local MMCs.