Use of multiattribute utility theory for formulary management in a health system.
OBJECTIVE
The application, utility, and flexibility of the multiattribute utility theory (MAUT) when used as a formulary decision methodology in a Korean medical center were evaluated.


METHODS
A drug analysis model using MAUT consisting of 10 steps was designed for two drug classes of dihydropyridine calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs). These two drug classes contain the most diverse agents among cardiovascular drugs on Samsung Medical Center's drug formulary. The attributes identified for inclusion in the drug analysis model were effectiveness, safety, patient convenience, and cost, with relative weights of 50%, 30%, 10%, and 10%, respectively. The factors were incorporated into the model to quantify the contribution of each attribute. For each factor, a utility scale of 0-100 was established, and the total utility score for each alternative was calculated. An attempt was made to make the model adaptable to changing health care and regulatory circumstances.


RESULTS
The analysis revealed amlodipine besylate to be an alternative agent, with the highest total utility score among the dihydropyridine CCBs, while barnidipine hydrochloride had the lowest score. For ARBs, losartan potassium had the greatest total utility score, while olmesartan medoxomil had the lowest.


CONCLUSIONS
A drug analysis model based on the MAUT was successfully developed and used in making formulary decisions for dihydropyridine CCBs and ARBs for a Korean health system. The model incorporates sufficient utility and flexibility of a drug's attributes and can be used as an alternative decision-making tool for formulary management in health systems.
Chung
Seonyoung
S
Department of Pharmaceutical Services, Samsung Medical Center, Gangnam-gu, Seoul, Korea.
Kim
Sooyon
S
Kim
Jeongmee
J
Sohn
Kieho
K
D000465:Algorithms; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003657:Decision Making; D003662:Decision Theory; D016527:Drug Costs; D005163:Factor Analysis, Statistical; D005572:Formularies, Hospital as Topic; D006801:Humans; D007723:Korea; D017060:Patient Satisfaction; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D010606:Pharmacy and Therapeutics Committee; D012449:Safety; D016896:Treatment Outcome; D014481:United States; D014486:United States Food and Drug Administration
D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers