title: Multi-indication Pharmacotherapeutic Multicriteria Decision Analytic Model for the Comparative Formulary Inclusion of Proton Pump Inhibitors in Qatar.
abstract: The formulary inclusion of proton pump inhibitors (PPIs) in the government hospital health services in Qatar is not comparative or restricted. Requests to include a PPI in the formulary are typically accepted if evidence of efficacy and tolerability is presented. There are no literature reports of a PPI scoring model that is based on comparatively weighted multiple indications and no reports of PPI selection in Qatar or the Middle East. This study aims to compare first-line use of the PPIs that exist in Qatar. The economic effect of the study recommendations was also quantified.
  
  
  
  A comparative, evidence-based multicriteria decision analysis (MCDA) model was constructed to follow the multiple indications and pharmacotherapeutic criteria of PPIs. Literature and an expert panel informed the selection criteria of PPIs. Input from the relevant local clinician population steered the relative weighting of selection criteria. Comparatively scored PPIs, exceeding a defined score threshold, were recommended for selection.
  
  
  
  Weighted model scores were successfully developed, with 95% CI and 5% margin of error. The model comprised 7 main criteria and 38 subcriteria. Main criteria are indication, dosage frequency, treatment duration, best published evidence, available formulations, drug interactions, and pharmacokinetic and pharmacodynamic properties. Most weight was achieved for the indications selection criteria. Esomeprazole and rabeprazole were suggested as formulary options, followed by lansoprazole for nonformulary use. The estimated effect of the study recommendations was up to a 15.3% reduction in the annual PPI expenditure. Robustness of study conclusions against variabilities in study inputs was confirmed via sensitivity analyses.
  
  
  
  The implementation of a locally developed PPI-specific comparative MCDA scoring model, which is multiweighted indication and criteria based, into the Qatari formulary selection practices is a successful evidence-based cost-cutting exercise. Esomeprazole and rabeprazole should be the first-line choice from among the PPIs available at the Qatari government hospital health services.
authors.affiliation: College of Pharmacy, Qatar University, Doha, Qatar. Electronic address: daoud.a@qu.edu.qa.
authors.forename: Daoud
authors.initials: D
authors.lastname: Al-Badriyeh
authors.affiliation: Biopharmaceutics and Clinical Pharmacy Department, Faculty of Pharmacy, The University of Jordan, Amman, Jordan.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Alabbadi
authors.affiliation: Clinical Support Services Unit, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Michael
authors.initials: M
authors.lastname: Fahey
authors.affiliation: Medical Education, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Abdullatif
authors.initials: A
authors.lastname: Al-Khal
authors.affiliation: Department of Pharmacy, Aspetar, Doha, Qatar.
authors.forename: Manal
authors.initials: M
authors.lastname: Zaidan
mesh_terms: D003661:Decision Support Techniques; D004347:Drug Interactions; D064098:Esomeprazole / Q000008:administration & dosage; D006801:Humans; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D011780:Qatar; D064750:Rabeprazole / Q000008:administration & dosage
chemical_list: D054328:Proton Pump Inhibitors; D064750:Rabeprazole; D064098:Esomeprazole
keywords: economics; multi-indication; multicriteria; proton pump inhibitors; qatar; scoring model; selection