Drug selection should be a rational process that embraces the principles of evidence-based medicine. However, many factors may affect the choice of agent. It is against this background that the System of Objectified Judgement Analysis (SOJA) process for rational drug-selection was developed. This article describes how the information on which the SOJA process is based, was researched and processed.
In the past few years biosimilars have penetrated the market following the expiry of patents of originator variants. This offers the opportunity to apply high-tech protein products at a lower cost. In contrast to small-molecule generics, clinicians and pharmacists have found it difficult to judge the efficacy and safety profiles of complex protein products. In recent years, the European Medicines Agency (EMA) has gained knowledge on assessing comparability between biosimilars and originator products in scientific and legal areas. This article provides an overview of an extensive set of 31 previously drawn biosimilar selection criteria and describes how several of these criteria are covered by EMA regulations and guidelines. A panel of experts (authors) reviewed the criteria and produced a shortlist of 10 criteria relevant for clinicians and pharmacists.
A number of medicine selection methods have been used worldwide for formulary purposes. In Northern Ireland, integrated medicines management is being developed, and related projects have been carried out. This paper deals with the description of the STEPS (Safe Therapeutic Economic Pharmaceutical Selection) programme. The paper outlines the development of STEPS and its application as an element of a cost-effective medicines-management process in Northern Ireland.
InforMatrix is a decision matrix technique by means of which a group of experts on a subject (health condition) determine, on the basis of agreed criteria, an order of merit for the various available treatment options for that condition. The goal of the InforMatrix program is to make a rational selection of first-choice medications or drugs following the evaluation of the clinical value of available therapeutic agents. This paper describes the InforMatrix methodology, and also provides an explanation of the various selection criteria that are used by the InforMatrix technique of drug selection.
This paper provides an overview of the use of matrix models within the context of Pharmacotherapy. It also discusses the application of these matrix models to the Safe Therapeutic Economic Pharmaceutical Selection (STEPS) approach used in Northern Ireland.
ACE inhibitors have proven to be effective blood pressure lowering agents with an excellent tolerability profile. The family of these drugs is still expanding, necessitating the definition of selection criteria in order to choose the "right drug". In this article the ACE inhibitors available in the United Kingdom (UK) are scored by means of the SOJA method. The System of Objectified Judgement Analysis (SOJA) method is a model for rational drug selection. The relevant selection criteria for a certain group of drugs are defined and judged by a panel of experts and each selection criterion is given a relative weight. The more important that a selection criterion is considered, the higher the relative weight that is given to that criterion. The ideal properties for each selection criterion are determined and each drug is scored as a percentage of the score of the ideal drug for all selection criteria. The following selection criteria were used (relative weight): number of formulations (20), number of indications (20), variation in bioavailability (40), interactions (40), trough/peak ratio diastolic blood pressure lowering effect (20), efficacy (250), side-effects (150), dosage frequency (100), documentation (100) and effect on clinical endpoints (260). Ramipril showed the highest score, followed by perindopril, lisinopril and enalapril. The well documented effects on clinically relevant end points, such as cardiovascular morbidity and mortality contributed to the high score for ramipril.
The modified SOJA approach has a significant contribution to make in containing the costs of ACEIs. Applying modified SOJA as a practical method for all indications will allow the development of a unified formulary that bridges secondary and primary care.
The findings suggested that product standardisation significantly influenced the prescribing pattern for compound alginate liquid preparations within primary care across Northern Ireland.
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