Background
In recent years, economic evaluations (EEs) have increasingly been used by government healthcare agencies, such as Australian Pharmaceutical Benefit Scheme in Australia or National Institute for Clinical Excellence in the UK, to make decisions about authorising public funding of new medicines, or to appraise the cost-effectiveness of new health technologies. Despite this, the role of EE is less well-defined in local settings and there are very few documented examples examining the use of economic evidence in supporting medicine-management decision-making.^[1-3] Medicine Management Committees (MMCs) of NHS Trusts are responsible for operational and strategic decision-making including the managed entry of new drugs, and for ensuring the appropriate use of medicines in local Trusts. Members of the MMCs generally include clinical consultants, pharmacists, financial managers and other medical staff. Pharmacists may be involved in reviewing and presenting evidence to the MMCs and joint discussions at MMC meetings. The aims of this study were to: (1) examine local-level decision makers’ opinions and perceptions on the usefulness of EEs, and (2) identify what factors influence the uptake of EE in decision-making within MMCs.

Method
This qualitative study included a two-stage process carried out during July and August 2004. Firstly, a researcher observed the decision-making process at two MMCs based in acute trusts in England. Handwritten notes were made during observation, which were later transcribed. Subsequently, in-depth semi-structured interviews were conducted with a purposive sample of pharmacists who were members of MMCs. The interviews explored pharmacists’ views and opinions on the usefulness of EEs in decision making, and the factors which could influence the uptake of economic evidence by the MMCs. The interviews were audiotaped and transcribed verbatim. All the transcribed data were subjected to thematic analysis using the constant comparison approach to cover identified and emerging themes.

Findings
In all, ten pharmacists who are members of the two MMCs were interviewed. Observational findings showed that pharmacists played an important role in medicine-related decision-making in hospitals, especially medicine information pharmacists who were responsible for reviewing and presenting economic evidence at the MMCs. However, most pharmacists felt that they were not confident in the use of economic evidence due to a lack of knowledge and training in health economics. EEs were regarded as being useful only when reviewing new medicines, but the actual use of economic evidence in local-level decision-making was limited. Problems identified to use EEs included the availability, acceptability and transferability of economic studies. However, the main barrier to implement economic evidence was that decision-makers were only concerned about the impact of introducing new drugs on local, short-term drug budgets, without considering the wider health economy.

Discussion
EEs aim to inform decision-making and affect policy. In order to improve the accessibility of economic studies in local decision-making, decision makers will need training in health economics; likewise, health economists will need to improve the transparency of data reporting and the value of economic results in local settings. However, under the restricted focus of local, short-term drug budgets, evidence-based and cost-effective decision-making remains a challenge for local MMCs.

1. Drummond M, Cooke J, Walley T. Economic evaluation under managed competition: evidence from the U.K. Social Science and Medicine 1997; 45(4): 583-595
2. Hoffmann C, Stoykova BA, Nixon J, Glanville JM, Misso K, Drummond MF. Do health-care decision makers find economic evaluations useful? The findings of focus group research in UK health authorities. Value in Health 2002; 5(2): 71-78.
3. Nixon J, Phipps K, Glanville J, Mugford M, Drummond M. Using economic evidence to support decision making: a case study of assertive community treatment within the UK National Service Framework for Mental Health. Applied Health Economics and Health Policy 2002; 1(4): 179-190.