What constitutes evidence in hospital new drug decision making?

Do economic evaluations have a role in decision-making in Medicine Management Committees? A qualitative study

“…Although the small and purposive sample limited the generalisability of our findings, this project has provided useful data on a difficult-to-research topic, and one of general interest to many pharmacists in different healthcare settings. The saturated themes of this study are also concordant with other studies conducted with various local decision makers in the UK [1,8,9].…”

“…Discussions at MMC meetings often considered a wider perspective than that of the hospitals; in particular primary care. However, other driving forces, such as ''peer persuasion'' [8] were used to supplemented decision-making, especially when there was no robust scientific evidence available.…”

“…Several UK-based studies have shown that local decision makers based in primary care and secondary care settings often seek different information in the decisionmaking processes, such as data on clinical effectiveness and safety, acquisition cost, impact on patient population or financial budgets [1,8,9]. Economic issues have been rated to be less important than clinical issues and drug acquisition costs by prescribing advisors [9], although it was generally believed by local decision makers that economic evaluations would become increasingly influential in the future [1].…”

“…As members of the MMCs, pharmacists are often charged with reviewing and presenting evidence to the MMCs, and hence play an important role in the decision-making process. Decisionmaking in MMCs has been described as a highly skilled and sensitive practice in which a negotiated agreement needs to be achieved [8]. However, little is known about the relevance and utilisation of economic evidence to the decision-making in MMCs.…”

Rhetoric, Evidence and Policymaking: a Case Study of Priority Setting in Primary Care*

“…A number of studies highlight the limitations of the technical, scientific model of decision-making. Coast, for example, describes studies that have shown how decision makers find technical data on costeffectiveness of limited use in practice (Coast, 2004), Williams and Bryan found that it was rare for cost-effectiveness analyses to inform technology coverage decisions of local formulary committees (Williams & Bryan, 2007), and Jenkings and Barber similarly report from their ethnographic study of decision-making in a drugs and therapeutics committee that costeffectiveness data was either inadequate or insufficient for a locally implementable decision (Jenkings & Barber, 2004).…”