Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL.
Center for Medication Utilization, Froedtert & the Medical College of Wisconsin, Milwaukee.
J Manag Care Spec Pharm. 2021 Apr;27(4):488-496. doi: 10.18553/jmcp.2021.27.4.488.
The value assessment framework (VAF) is one approach to assessing the evidence and value of medications. VAFs are a way to measure and communicate the value of medications and other health care technologies for decision-making purposes. Given the increasing number of high-cost medications, challenging formulary inquiries, and critiques of currently available tools, health systems need to explore a standardized way to incorporate value assessment into formulary decision making. To (a) evaluate existing VAFs by measuring inter-rater reliability among typical clinicians completing formulary reviews and (b) explore general implications of applying these tools to formulary decision making for all medications at a large academic health system. This was a retrospective, observational study at a single health system. A list of medications added, denied, and removed from the system formulary from September 1, 2013, through August 31, 2018, was collected. Published VAFs, such as the American Society of Clinical Oncology (ASCO) Value Framework, European Society of Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale, National Comprehensive Cancer Network (NCCN) Evidence Blocks, American College of Cardiology/American Heart Association Value Framework, and the incremental cost-effectiveness ratio (ICER) calculation were applied by 3 different reviewer groups. The primary outcome was inter-rater reliability among the 3 different reviewers for a given framework. Cohen's weighted kappa and the intraclass correlation coefficient (ICC) were used to assess inter-rater reliability. The frameworks were applied to 94 medications. The VAFs with the highest ICCs between all 3 raters were NCCN (0.635; 95% CI = 0.387-0.823) and ASCO (0.634; 95% CI = 0.370-0.832), both indicating moderate inter-rater reliability. The VAFs with the lowest ICCs were ESMO (0.368; 95% CI = 0.126-0.611) and ICER (0.159; 95% = CI -0.018-0.365), with ICCs corresponding to poor reliability. Because high-cost medications are a challenge to health systems, VAFs may be beneficial to target formulary decision making in this setting. Applying VAFs proactively may improve interrater reliability and usability in formulary decision making. No outside funding supported this study. The authors have nothing to disclose.
价值评估框架（VAF）是评估药物证据和价值的一种方法。VAF 是一种衡量和沟通药物和其他医疗保健技术价值的方法，旨在为决策目的服务。鉴于越来越多的高成本药物、具有挑战性的处方查询以及对现有工具的批评，卫生系统需要探索一种将价值评估纳入处方决策的标准化方法。本研究旨在通过评估典型临床医生在进行处方审查时的评分者间可靠性，评估现有的 VAF，并探讨在大型学术医疗系统中对所有药物应用这些工具进行处方决策的一般意义。这是一项在单一医疗系统中进行的回顾性观察研究。收集了 2013 年 9 月 1 日至 2018 年 8 月 31 日期间系统处方中添加、拒绝和删除的药物清单。应用了已发表的 VAF，如美国临床肿瘤学会（ASCO）价值框架、欧洲肿瘤内科学会（ESMO）临床获益量表、国家综合癌症网络（NCCN）证据块、美国心脏病学会/美国心脏协会价值框架和增量成本效益比（ICER）计算。由 3 个不同的评审组应用了这些框架。主要结果是给定框架下 3 个不同评审者之间的评分者间可靠性。采用 Cohen 加权 Kappa 和组内相关系数（ICC）评估评分者间可靠性。该框架应用于 94 种药物。所有 3 名评分者之间 ICC 最高的 VAF 是 NCCN（0.635；95%CI=0.387-0.823）和 ASCO（0.634；95%CI=0.370-0.832），均表明中度评分者间可靠性。ICC 最低的 VAF 是 ESMO（0.368；95%CI=0.126-0.611）和 ICER（0.159；95%CI=-0.018-0.365），ICC 对应于可靠性差。由于高成本药物对卫生系统构成挑战，VAF 可能有助于针对该环境下的处方决策。主动应用 VAF 可能会提高处方决策中的评分者间可靠性和可用性。本研究无外部资金支持。作者没有要披露的内容。
