Martin Douglas K, Hollenberg Daniel, MacRae Sue, Madden Shannon, Singer Peter
Joint Center for Bioethics, University of Toronto, 88 College Street, Toronto, Ont., Canada M5G 1L4.
Health Policy. 2003 Dec;66(3):295-303. doi: 10.1016/s0168-8510(03)00063-0.
Dramatically rising costs for new drugs are posing major challenges for hospital budgets. In response to these pressures, hospitals must set priorities for which drugs they will list on their formularies. While there have been studies relevant to decision making in hospitals regarding drugs, none have described how priority setting for drugs in hospitals is done and evaluated it against a framework of how it should be done. In this paper we describe the process of priority setting for new drugs in a hospital formulary and evaluate it using a leading conceptual framework for healthcare priority setting--Daniels and Sabin's 'accountability for reasonableness'. The findings from this study provide an evidence base for developing strategies to improve this hospital's priority setting regarding its drug formulary. The process we utilized here, describing using case study methods and evaluating using 'accountability for reasonableness', is a generalizable process for improving the fairness of priority setting in hospital drug formularies.
新药成本的急剧上升给医院预算带来了重大挑战。为应对这些压力，医院必须确定将哪些药物列入其药品目录的优先顺序。虽然已经有与医院药品决策相关的研究，但没有一项研究描述过医院如何确定药品的优先顺序，也没有根据应如何确定优先顺序的框架对其进行评估。在本文中，我们描述了医院药品目录中确定新药优先顺序的过程，并使用医疗保健优先顺序确定的领先概念框架——丹尼尔斯和萨宾的“合理性问责制”对其进行评估。这项研究的结果为制定策略以改善该医院药品目录的优先顺序确定提供了证据基础。我们在此采用的过程，即使用案例研究方法进行描述并使用“合理性问责制”进行评估，是提高医院药品目录优先顺序确定公平性的可推广过程。
