INCORPORATING QUALITY-OF-LIFE DATA INTO MANAGED CARE FORMULARY DECISIONS - A CASE-STUDY WITH SALMETEROL

Pharmacy and Therapeutics committees of managed care organizations hav e traditionally developed formularies by limiting the numbers and kind s of pharmaceuticals they purchase, with the goal of cutting costs. Th ese attempts to manage pharmaceutical costs do not take into account t he interrelationship of the costs of various components of care; thus, drug costs may decrease, but expenditures for utilization of other re sources may increase, Cost-minimization and basic cost-effectiveness s tudies, on which many prior-authorization and formulary programs are b ased, only evaluate only the cost of the drug and its effectiveness. H owever, with the heightened competition in the healthcare market, emph asis is increasingly being laid on patient satisfaction and outcomes. Cost-utility analysis is a potentially superior pharmacoeconomic tool because it evaluates the effect of drug therapy on quality of life; ho wever, data from such analyses are seldom readily available to the com mittees that evaluate a drug's potential effects on the entire healthc are system. The purpose of this review is to stress the importance of approaching formulary management from a wider perspective and to empha size that the results of cost-utility studies should be proactively ev aluated and incorporated into decisions regarding formularies. This is especially important for symptom-intensive diseases, such as asthma, in which the quality of life can be notably impaired. Cost-utility ana lyses should be conducted for all newer therapies, such as salmeterol, which are highly effective and which have a positive impact on qualit y of life, to determine the overall effect on the managed care plan's budget.