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About the study

A pilot study examining criteria used to select drugs for hospital, provincial and national formularies J Robertson, D Newby, T Pillay, E. Walkom. About the study. Questionnaire survey Members of Australian PBAC/ESC Members of 6 provincial PTCs in South Africa

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About the study

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  1. A pilot study examining criteria used to select drugs for hospital, provincial and national formularies J Robertson, D Newby, T Pillay, E. Walkom

  2. About the study • Questionnaire survey • Members of Australian PBAC/ESC • Members of 6 provincial PTCs in South Africa • Participants in pharmacoeconomics short course • Objectives of the study • Establish importance of 22 criteria for selecting drugs for inclusion in national, provincial or hospital formularies • Compare ratings of criteria between 3 groups surveyed

  3. Results • Clinical factors • Efficacy and safety were most important factors • Availability of other treatment options important • Quality of life less important than efficacy, safety • Cost factors • Cost-effectiveness important criterion in SA • Cost offsets ranked more highly in SA • Pharmacological factors varied by setting • Other factors • External pressure sometimes an influence in all settings

  4. Our intentions • Survey instrument • Decision-making criteria, information sources, understanding of clinical & economic terms • Australia: national, hospital P&T committee • Feedback responses on importance of criteria • Explore complexity using hypothetical scenarios • South Africa: provincial PTCs • ? Discuss scenarios with committee members • Others: opportunistic • Short course participants, other contacts • ? Survey only

  5. Variable response rates • Pilot in Australian hospital area PTC (postal) • 2/17 responses, no interest in phase II • SA PTCs, (completed as part of meeting) • 100% response rate but limited time to complete • SA PTC (started in meeting, to return by post) • 0% response, Relevance of participating? • Threatening questions? Lack of interest? • Modified for Australian PBAC/ESC (postal) • 9 PBAC, 2 ESC members responded • Short course (completed as part of workshop) • 100% response rate

  6. Scientifically rational description of decision-making • Survey did not focus on specific examples • Importance of criteria across all decisions • Could not identify when criteria may be more or less important • Could not capture complexity of decisions • ? Expected responses, consistent with NDP • Modified survey for PBAC/ESC • How important is criterion for decision-making? • How important should it be for decision-making?

  7. Uncertainty in interpretation of terms • Survey in English; pilot tested Australia, SA • Aware of ‘difficult’ knowledge questions • Assessing capacity of committee, not individuals • Modified approach for more recent surveys • No chance to clarify questions, responses • Meaning of cost-effectiveness (Doubilet 1986) • Cost saving • Effective • Cost savings with equal or better outcomes • Having additional benefits worth additional cost

  8. Failed to capture complexity of decision-making and engage decision-makers • Opinions and views of whole committee may not be sum of individual views • Not account for group dynamics • Time pressure to complete complex survey may compromise quality of responses • Work not of sufficient interest or perceived importance to encourage responses • Threatening nature of knowledge questions may have discouraged completion of survey

  9. Our lessons • Survey too complex; tried to do too much • Knowledge questions were threatening • Not appropriate method for capturing complexities of decision-making process • Need examples to anchor questions • Trade-off quantity vs quality of information • Surveys - larger numbers, variety of settings, low cost • Jenkings & Barber SocSciMed 2004;58(9):1757-1766 observed meetings, analysed taped discussions, assessed local context

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