Statins Formulary Selection in Qatar, Based on Multi-Indication Pharmacotherapeutic Multi-Criteria Scoring, and Clinician Preference

Purpose: Statins selection for the largest hospital formulary in Qatar is not systematic, not comparative, not cost saving, and does not consider the multi-indication nature of statins. There are no literature reports of multi-indication based comparative scoring models of statins, or reports of statins selection criteria weights that are primarily based on local clinicians' preference and experiences. The study sought to comparatively evaluate statins for first-line therapy in Qatar, and to evaluate the economic impact of this. Methods: An evidence-based, multi-indication, multi-criteria pharmacotherapeutic model was developed for the scoring of statins. This was from the perspective of the main healthcare provider in Qatar, the Hamad Medical Corporation (HMC). Literature and an expert panel informed the selection criteria of statins. Relative weighting of selection criteria was based on the input of the relevant local clinician population. The targeted clinician population was of all specialists and consultants in the departments of cardiology, internal medicine, and nephrology in HMC. Statins were comparatively evaluated according to their total pharmacotherapeutic selection scores, with only the statins that score more than 95% of the highest scoring statin getting recommended for formulary inclusion. Remaining statins that score more than 90% of the highest scoring statin will also be considered, but as non-formulary alternative. The remaining did not progress. Sensitivity analyses were conducted to investigate the robustness of the study outcomes against variations in study inputs. These included deterministic, probabilistic as well as scenario analyses, via @Risk-5.5 Palisade, USA. Findings: This is the first literature report to inform formulary inclusion in Qatar or the Middle Eastern region, and the first in literature that comparatively score statins based on multiple indications, as compared to the typical pharmacoeconomics evaluation method, comparing differences in cost and effect between two statins for an indication of interest to guide the formulary inclusion decisions. With 95% confidence interval and 5% margin of error, the scoring model was successfully developed. Selection criteria comprised 28 sub-criteria, under the following main criteria: clinical efficacy, best publish evidence and experience, adverse effects, drug interaction, dosing time, and fixed dose combination availability. Outcome measures of multiple indications related to effects on LDL-cholesterol, HDL-cholesterol, triglyceride, total cholesterol, and c-reactive protein. Atorvastatin, pravastatin and rosuvastatin exceeded defined pharmacotherapeutic thresholds. Atorvastatin and pravastatin were suggested for first-line use in HMC, followed by rosuvastatin as a non-formulary alternative. Fluvastatin and simvastatin were recommended for exclusion from any hospital drug lists. This was estimated to produce 17.6% in cost savings, reducing the annual statins expenditure from QAR 152, 118, 200 to QAR 125, 367, 620;. Sensitivity analyses confirmed the robustness of the evaluation outcomes. The comparative criterion that affected the study conclusion was the availability of fixed dose combination. The possibility of 30% non-formulary drug utilization scenario resulted in an annual expenditure of QAR 129, 654, 180, still associated with up to 14.8% cost saving. Implications: Incorporating a comparative evaluation of statins in Qatari practices, based on a locally-developed, transparent, multi-indication, multi-criteria scoring model, has the potential to considerably reduce the expenditure on statins. Atorvastatin and pravastatin should be the first-line statin therapies in the main Qatari healthcare provider, with rosuvastatin as an alternative. Important, is that the study results are consistent with published clinical guidelines, as well as with practices in overseas.qscienc

Multi-indication Pharmacotherapeutic Multicriteria Decision Analytic Model for the Comparative Formulary Inclusion of Proton Pump Inhibitors in Qatar

Purpose The formulary inclusion of proton pump inhibitors (PPIs) in the government hospital health services in Qatar is not comparative or restricted. Requests to include a PPI in the formulary are typically accepted if evidence of efficacy and tolerability is presented. There are no literature reports of a PPI scoring model that is based on comparatively weighted multiple indications and no reports of PPI selection in Qatar or the Middle East. This study aims to compare first-line use of the PPIs that exist in Qatar. The economic effect of the study recommendations was also quantified. Methods A comparative, evidence-based multicriteria decision analysis (MCDA) model was constructed to follow the multiple indications and pharmacotherapeutic criteria of PPIs. Literature and an expert panel informed the selection criteria of PPIs. Input from the relevant local clinician population steered the relative weighting of selection criteria. Comparatively scored PPIs, exceeding a defined score threshold, were recommended for selection. Findings Weighted model scores were successfully developed, with 95% CI and 5% margin of error. The model comprised 7 main criteria and 38 subcriteria. Main criteria are indication, dosage frequency, treatment duration, best published evidence, available formulations, drug interactions, and pharmacokinetic and pharmacodynamic properties. Most weight was achieved for the indications selection criteria. Esomeprazole and rabeprazole were suggested as formulary options, followed by lansoprazole for nonformulary use. The estimated effect of the study recommendations was up to a 15.3% reduction in the annual PPI expenditure. Robustness of study conclusions against variabilities in study inputs was confirmed via sensitivity analyses. Implications The implementation of a locally developed PPI-specific comparative MCDA scoring model, which is multiweighted indication and criteria based, into the Qatari formulary selection practices is a successful evidence-based cost-cutting exercise. Esomeprazole and rabeprazole should be the first-line choice from among the PPIs available at the Qatari government hospital health services. 2016 Elsevier HS Journals, Inc.The work was reviewed and funded by the National Priority Research Programme, Qatar National Research Fund (NPRP-5-284-3-083), Qatar Foundation, Doha, Qatar. No funding from a pharmaceutical industry was received.Scopu

Implications of external price referencing of pharmaceuticals in Middle East countries

<div><p>Introduction: External price referencing (EPR) is applied frequently to control pharmaceutical prices. Our objective was to analyse how EPR is used in Middle Eastern (ME) countries and to compare the price corridor for original pharmaceuticals to non-pharmaceutical services not subjected to EPR. Methods: We conducted a survey on EPR regulations and collected prices of 16 patented pharmaceuticals and 14 non-pharmaceutical services in seven Middle Eastern (ME) countries. Maximum and minimum prices of each pharmaceutical and non-pharmaceutical technology were compared to mean prices in the countries studied by using market exchange rates. Influencing factors of pharmaceutical prices were assessed by multivariate linear regression analysis. Results: The average price corridor is narrower for pharmaceuticals (−39.8%; +35.9%) than for outpatient and hospital services (−81.7%; +96.3%). Conclusion: Our analysis revealed the importance of population size and EPR implementation on drug price levels; however, EPR results in higher pharmaceutical prices in lower-income countries compared to non-pharmaceutical services.</p></div