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What constitutes evidence in hospital new drug decision making?

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  • Jenkings, K Neil
  • Barber, Nick

Abstract

In National Health Service hospitals in the UK the introduction of new drugs is controlled by a local Drug and Therapeutics Committee (DTC), which is expected to apply the principles of evidence-based medicine (EBM). In the light of growing expenditure on drugs, there is interest in how the decisions are made that lead to the local acceptance or rejection of a new drug. In this study the DTCs of two general hospitals were observed, tape-recorded and analysed to determine what was considered as evidence and how it was used in decision making. Evidence, as constituted by DTC members, was issues that affected the decision-making process and included: clinical trial data, cost, pre-existing prescribing of the drug, pharmaceutical company activities, decisions of other DTCs, patient demand, clinician excitement, and personality of the applicant. Debate usually started with a discussion of the scientific evidence, then the cost would be considered. Often this evidence was either inadequate or insufficient enough for a locally implementable decision and further types of evidence would be brought in to try and estimate the likely impact of adopting the new drug. EBM, while used in decision making, was supplemented by local knowledge, although decisions were accounted for in the language of scientific rationality. Both abstract scientific rationality and the local rationality of practical healthcare provision were present in the decisions of the DTCs on the adoption, or otherwise, of new drugs into local formularies and healthcare. We suggest the coming together of local and abstract in local decision-making needs to be taken into account when formulating policy and providing decision support.

Suggested Citation

  • Jenkings, K Neil & Barber, Nick, 2004. "What constitutes evidence in hospital new drug decision making?," Social Science & Medicine, Elsevier, vol. 58(9), pages 1757-1766, May.
  • Handle: RePEc:eee:socmed:v:58:y:2004:i:9:p:1757-1766
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    Citations

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    Cited by:

    1. Gregory Merlo & Katie Page & Julie Ratcliffe & Kate Halton & Nicholas Graves, 2015. "Bridging the Gap: Exploring the Barriers to Using Economic Evidence in Healthcare Decision Making and Strategies for Improving Uptake," Applied Health Economics and Health Policy, Springer, vol. 13(3), pages 303-309, June.
    2. Eddama, Oya & Coast, Joanna, 2008. "A systematic review of the use of economic evaluation in local decision-making," Health Policy, Elsevier, vol. 86(2-3), pages 129-141, May.
    3. Armstrong, Kristy & Mitton, Craig & Carleton, Bruce & Shoveller, Jean, 2008. "Drug formulary decision-making in two regional health authorities in British Columbia, Canada," Health Policy, Elsevier, vol. 88(2-3), pages 308-316, December.
    4. Williams, Iestyn & Bryan, Stirling, 2007. "Understanding the limited impact of economic evaluation in health care resource allocation: A conceptual framework," Health Policy, Elsevier, vol. 80(1), pages 135-143, January.
    5. Vuorenkoski, Lauri & Toiviainen, Hanna & Hemminki, Elina, 2008. "Decision-making in priority setting for medicines--A review of empirical studies," Health Policy, Elsevier, vol. 86(1), pages 1-9, April.
    6. Russell, Jill & Greenhalgh, Trisha, 2012. "Affordability as a discursive accomplishment in a changing National Health Service," Social Science & Medicine, Elsevier, vol. 75(12), pages 2463-2471.
    7. Lin, Shu-Jou & Jan, Kuan-An & Kao, Jen-Tse, 2011. "Colleague interactions and new drug prescribing behavior: The case of the initial prescription of antidepressants in Taiwanese medical centers," Social Science & Medicine, Elsevier, vol. 73(8), pages 1208-1213.
    8. Jommi, Claudio & Costa, Enrico & Michelon, Alessandra & Pisacane, Maria & Scroccaro, Giovanna, 2013. "Multi-tier drugs assessment in a decentralised health care system. The Italian case-study," Health Policy, Elsevier, vol. 112(3), pages 241-247.
    9. Williams, Iestyn P. & Bryan, Stirling, 2007. "Cost-effectiveness analysis and formulary decision making in England: Findings from research," Social Science & Medicine, Elsevier, vol. 65(10), pages 2116-2129, November.
    10. Eddama, Oya & Coast, Joanna, 2009. "Use of economic evaluation in local health care decision-making in England: A qualitative investigation," Health Policy, Elsevier, vol. 89(3), pages 261-270, March.
    11. Wirtz, Veronika & Cribb, Alan & Barber, Nick, 2005. "Reimbursement decisions in health policy--extending our understanding of the elements of decision-making," Health Policy, Elsevier, vol. 73(3), pages 330-338, September.
    12. Prosser, Helen & Walley, Tom, 2006. "New drug prescribing by hospital doctors: The nature and meaning of knowledge," Social Science & Medicine, Elsevier, vol. 62(7), pages 1565-1578, April.

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