Reflections on the Formulary System from 1997 to the Present.

DISCLOSURES: No funding was received for the writing of this reflection. Avey is a member of the AMCP Foundation and has recently retired from MedImpact Health Systems, where he served as Vice President of Specialty Clinical Solutions.

[Tai ping sheng hui fang (Taiping Holy Prescriptions for Universal Relief) and the compilation during the early Song Dynasty].

Tai ping sheng hui fang, the first medical formulary of the Song Dynasty, compiled from the 3(rd) year of Taiping-xingguo reign to the 3(rd) year of Chunhua reign (978 ∼ 992), under the edict of the Taizong Emperor, was popularly applied and extensively circulated and called "the first formulary of the Dynasty". It is extremely significant in the medical history of the Song Dynasty due to its theory of prescription art, practical prescriptions and clinical practice. During the process of its circulation, different versions appeared, including the Guozijian Orthodox Version, Guozijian Small-character Version, Chongwen Hall Abridged Version, Newly Carved Version of Zhuanyunsi, and the Local Abridged Version, thus adapting to the demands of various walks of life in the society. Its unique role in the development of the Song society was founded by its introduction, application and popularization by the emperors, local officials, medical scholars, diplomatic envoys, and intellectuals. The "kind administration" of the authority and the government was further greatly facilitated by the involvement of the government and the introduction of printing. Its practical prescriptions became forceful tools to prevent and treat diseases, to conquer witchcraft, to protect local social security, and to pronounce the merits of officials and physicians at all levels.

Historical lifetimes of drugs in England: application to value of information and cost-effectiveness analyses.

OBJECTIVES: The expected lifetime of a health technology is a critical parameter in value of information analysis and in two methodologies for cost-effectiveness analysis which have recently been suggested. The first method allows for the possibility that a superior technology will become available in the future. The second advocates modeling both the prevalent and all future incident patient cohorts. Unfortunately, for value of information analysis, the period of time over which information about the decision problem would be useful is very uncertain, and existing estimates are seemingly arbitrary. Furthermore, there is very little literature on the historical lifetimes of technologies. Here, I quantify and analyze the historical lifetimes of drugs in England. I then apply this information to inform the value of further research and the cost-effectiveness of health technologies. METHODS: A Weibull regression model was fitted to the historical drug lifetimes of 455 drugs. These represented all British National Formulary drugs in England which were launched from 1981 to 2007, and which did not have very low sales volumes. RESULTS: The mean drug lifetime was 57 years (95% confidence interval 39-79 years), and the median was 46 years (35-60 years). Drugs with low sales volumes tended to have shorter lifetimes. Under certain assumptions, the ratio of population level to per-year expected value of information is 21. Drug lifetimes are used to parameterize the two models of cost-effectiveness. CONCLUSIONS: The distribution function of the historical lifetimes of drugs can inform suitable time horizons for: 1) value of information; and 2) cost-effectiveness analyses related to drugs.

Historical perspective on adding drugs to Medicare.

This article describes the lengthy background and debate leading up to the passage of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). Full implementation of the prescription drug aspect of the law will not be completed for some time, and final assessment of its impact awaits a history yet to be written. Instead, this article summarizes the efforts of supporters until they finally managed to succeed after being stymied so many times in the preceding four decades.

[Iodine usage about 1880 by Antoine de Finance's formulary]. / L'usage therapeutique de l'iode vers 1880 a travers le formulaire magistral personnel d'Antoine de Finance, medecin de famille.

After the discovery of iodine by Courtois in 1812, this metal was very much in vogue for all the XIXth century for the treatment of numerous diseases. Antoine de Finance (1846-1898), family physician, described iodine and iodine derivatives usage in his own formulary, following the usual contemporary references (Bouchardat, Dorvault). As for those references, iodine was useful for diseases as different as lung diseases, tumors and syphilis but he added angor. As opposed to Bouchardat that used more than 129 formulations for iodine and iodine derivatives, Antoine de Finance is limited to 6 of them. This trend of using iodine for medicine will continue after the XIXth century and will remain essential at the beginning of the XXth century with the discovery of stable iodinated oils such as Lipiodol created in 1901 and first used for syphilis. This therapeutic usage of iodine will remain until today for preventive and curative treatment of iodine deficiency disorders.

A review of limited lists and formularies: are they cost-effective?

The 'limited list' or 'formulary' concept has been used to promote rational use of drugs and to set standards for drug use. Recently the concept has been aimed more toward containment of drug costs. Effective hospital formulary systems assist in purchasing and inventory management. Application of the formulary concept has resulted in savings within specific classes of drugs and in total hospital drug costs. Key features which promote effectiveness are development of policies by prescriber consensus and continued education along with feedback on drug usage. The formulary concept also provides a foundation for appropriate use of drugs in hospitals. In the community setting, limited lists can achieve cost savings and can assist in the rational use of drugs. National limited lists have been less successful in controlling overall drug costs, probably because they have focused on economic effects, rather than education, feedback or user participation. Properly organised drug rationalisation policies embracing the limited list concept can improve health outcomes by promoting rational drug use. They can also contain or reduce drug costs.