The practical impact of pharmacoeconomics on institutional managers.

The value of pharmacoeconomics has been advocated by governments and academic establishments worldwide. However, the importance of pharmacoeconomic information to healthcare decision makers will depend upon the viewpoint from which the analysis is conducted. Institutional decision makers are likely to be concerned more with direct than with total costs, and to be influenced more by arguments that apply to the economic effects on the institution than by a societal perspective. Formularies have been employed for a considerable length of time, but their effectiveness has been assessed in terms of cost savings rather than overall value in healthcare outcomes. Many governments and institutions now advocate the importance of contracting for health gain by emphasising the importance of effectiveness of therapeutic interventions. By subjecting treatments to clinical audit, maximum effectiveness can be sought while minimising toxicity and improving compliance with medication through risk management strategies. Pharmacoeconomic evaluations will have maximum impact when there is wide flexibility in the management of resource allocation by virement between different budgets. The consideration of all costs and benefits as parts of a single healthcare budget would satisfy the majority of these needs and maximise the use of healthcare resources.