Pharmacoeconomics and clinical practice guidelines. A survey of attitudes in Swedish formulary committees.

BACKGROUND: Swedish formulary committees are expected to influence prescribing practice by establishing and issuing drug lists and clinical practice guidelines, particularly now that financial responsibility for prescription drugs has been transferred from the national to the county council level. OBJECTIVE: The purpose of this exploratory study was to identify the information sources and decision criteria that individual committee members perceive as important in establishing clinical practice guidelines. Moreover, obstacles to the increased use of pharmacoeconomic evaluations in decision-making were also identified. DESIGN AND SETTING: Data were gathered through a survey questionnaire administered in 1998 to members of central formulary committees throughout Sweden, as determined by a national register. PARTICIPANTS: 312 members of central formulary committees, of whom 69% responded. RESULTS: Treatment policies/guidelines supplied by government authorities, or found in reviewed journals, are considered the most important sources of information, and criteria associated with costs and effects are considered the most important decision criteria. The members' years of experience and their professions affect their assessments of information sources, whereas education in health economics affects their assessments of decision criteria. Committee members voiced an interest in pharmacoeconomic issues, but warned that there was neither sufficient competence among committee members nor an adequate supply of relevant studies. Furthermore, a majority of the members identified difficulty in translating study results into clinical practice guidelines and limited possibilities in comparing studies as obstacles to the increased use of pharmacoeconomic evaluations. CONCLUSIONS: The results of this survey may be useful in designing future economic evaluations and when presenting and diffusing study results.

Use of the ACCES model to predict the health economic impact of celecoxib in patients with osteoarthritis or rheumatoid arthritis in Norway.

A Norwegian customization of the Arthritis Cost Consequence Evaluation System (ACCES) pharmacoeconomic model was used to predict the economic and health impact of the introduction of celecoxib in Norway. The model predicts that use of celecoxib can be expected to result in a reduction in gastrointestinal events with concomitant annual net savings of at least Norwegian krone (NOK) 580 per osteoarthritis (OA) patient and NOK 514 per rheumatoid arthritis (RA) patient. In a cost-effectiveness analysis, celecoxib demonstrated economic dominance (i.e. improved health at reduced cost) compared with the currently available alternatives. In sensitivity analyses, the results of this model have been shown to be relatively robust, with celecoxib demonstrating economic dominance or favourable cost-effectiveness ratios in all analyses. Based on these data, it can be concluded that the introduction of celecoxib into the Norwegian non-steroidal anti-inflammatory drug market, and its use as a first-line agent, will provide societal benefits by improving health care at reduced cost in patients with OA and RA.

The Swedish ACCES model: predicting the health economic impact of celecoxib in patients with osteoarthritis or rheumatoid arthritis.

The Arthritis Cost Consequence Evaluation System (ACCES) pharmacoeconomic model was used to evaluate the economic and health impact of the recent introduction of celecoxib for treatment of osteoarthritis (OA) and rheumatoid arthritis (RA) in Sweden. The model demonstrates that use of celecoxib can be expected to reduce the incidence of gastrointestinal adverse events, resource utilization and treatment costs. In a cost-effectiveness analysis, celecoxib demonstrated economic dominance (i.e. improved health at reduced cost) compared with the currently available alternatives for OA, and demonstrated economic dominance against a clinically relevant base-case scenario for RA. In sensitivity analyses, the results were shown to be relatively robust; celecoxib demonstrated economic dominance or favourable cost-effectiveness ratios in all analyses. Based on these data, it can be concluded that the use of celecoxib in Sweden will provide societal benefits by improving health care at reduced cost for patients with OA and RA.