Access to new cardiovascular therapies in Canadian hospitals: a national survey of the formulary process.
BACKGROUND
Access to new therapies in hospitals depends upon both clinical trial evidence and local Pharmacy and Therapeutics (P&T) committee approval. The process of formulary evaluation by P&T committees is not well-understood.


OBJECTIVE
To describe the formulary decision-making process in Canadian hospitals for cardiovascular medications recently made available on the Canadian market.


METHODS
Postal survey of hospital pharmacy directors in all Canadian hospitals with more than 50 beds. Target drugs included abciximab, enoxaparin, dalteparin, clopidogrel, eptifibatide and tirofiban.


RESULTS
Of 428 surveys mailed, responses were received from 164 P&T committees representing 350 hospitals for an effective response rate of 82%. While physicians make up the largest proportion of committee membership, pharmacists play an influential role. Information most commonly cited as influencing formulary decisions included published clinical trials (97%), regional guidelines (90%), pharmacoeconomic data (84%), decisions at peer hospitals (73%) and local opinion leaders (60%). However, this information was often not required on formulary applications. Approval timelines varied widely for target medications but there were no regional, hospital or P&T committee characteristics that were independent predictors of early formulary application or approval.


CONCLUSIONS
There is wide variability in the time taken for Canadian institutions to adopt new cardiovascular therapies, which is not explained by regional, hospital or P&T committee characteristics. Standardization of the formulary application and evaluation processes, including sharing of information amongst institutions, would lead to broader understanding of the applicable issues, more objectivity and improved efficiency.
Shalansky
Stephen J
SJ
Pharmacy Department, St. Paul's Hospital, Vancouver, British Columbia. shalansk@interchange.ubc.ca
Virk
Roohina
R
Ackman
Margaret
M
Jackevicius
Cynthia
C
Kertland
Heather
H
Tsuyuki
Ross
R
Humphries
Karin
K
D000077284:Abciximab; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use; D002170:Canada; D002317:Cardiovascular Agents / Q000191:economics / Q000627:therapeutic use*; D000077144:Clopidogrel; D017985:Dalteparin / Q000191:economics / Q000627:therapeutic use; D003625:Data Collection; D004363:Drug Utilization; D017984:Enoxaparin / Q000191:economics / Q000627:therapeutic use; D000077542:Eptifibatide; D005572:Formularies, Hospital as Topic / Q000592:standards*; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration*; D006401:Hematologic Agents / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000191:economics / Q000627:therapeutic use; D010455:Peptides / Q000191:economics / Q000627:therapeutic use; D010606:Pharmacy and Therapeutics Committee / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D000077466:Tirofiban; D014443:Tyrosine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D002317:Cardiovascular Agents; D017984:Enoxaparin; D006401:Hematologic Agents; D007140:Immunoglobulin Fab Fragments; D010455:Peptides; D014443:Tyrosine; D000077144:Clopidogrel; D000077466:Tirofiban; D000077542:Eptifibatide; D013988:Ticlopidine; D017985:Dalteparin; D000077284:Abciximab