A research project conducted by a team of Qatar University (QU) researchers and external collaborators using the formulary inclusion of proton pump inhibitors (PPIs) in Hamad Medical Corporation (HMC) health services will contribute to advancing the health care in Qatar and the region.
The team includes lead principal investigator of the project and Associate Professor of Pharmacoeconomics and Outcomes Research at QU College of Pharmacy (CPH) Dr Daoud Al Badriyeh, QU College of Medicine (CMED) Interim Associate Dean for Clinical Affairs and HMC Deputy Chief of Staff for Graduate Medical Education Dr Abdullatif Al Khal, Professor at Faculty of Pharmacy Department of Biopharmaceutics and Clinical Pharmacy in the University of Jordan Dr Ibrahim Alabbadi, HMC former Pharmaceutical Advisor and King’s College Hospital (KCH) Healthcare LLC Pharmacy Consultant Dr Michael Fahey, and Aspetar Department of Pharmacy Director Dr Manal Zaidan.
They have completed a study entitled “Multi-indication Pharmacotherapeuthic Multicriteria Decision Analytic Model for the Comparative Formulary Inclusion of Proton Pump Inhibitors in Qatar”. The project was funded by the National Priorities Research Program (NPRP) of the Qatar National Research Fund (QNRF).
The team developed a comparative evidence-based multi-criteria decision analysis (MCDA) model to compare first-line use and evaluate the different PPIs that are currently available in the HMC drug formulary. The model comprised seven main criteria and 38 subcriteria. Main criteria are indication, dosage frequency, treatment duration, best published evidence, available formulations, drug interactions, and pharmacokinetic and pharmacodynamics properties. A novel pharmacotherapeutic selection scoring model was developed for the ranking of the PPIs by an expert panel. PPIs were sorted with only the entities that score more than 95% of the highest scoring PPI getting recommended for formulary inclusion. PPIs that score more than 90% of the highest scoring PPI were also considered, but as a non-formulary alternative. Remaining entities were rejected. The study showed that esomeprazole and rabeprazole are formulary options, while lansoprazole is best for non-formulary use.
Commenting on the study, Dr Daoud Al Badriyeh said:
The MCDA modeling is a current hot area of interest in the science of decision making. It reflects real-life practices by relying on a range of clinically relevant criteria and indications that a drug can have. Basically fixing the inherent limitations associated with the cost-effectiveness evaluations traditionally used by advanced practices throughout the world for the drug selection. In addition, unlike most clinical guidelines, MCDA enables decision making that is not only efficacy and safety based. Important, is the estimated effect of the study recommendations, which was up to a 16.3% reduction in the annual PPI expenditure. There are no literature reports of a PPI scoring model that is based on comparatively weighted multiple indications and no reports of PPI selection in Qatar and the region. The implementation of a locally developed PPI-specific comparative MCDA scoring model into the Qatari formulary selection practices is a successful evidence-based cost-cutting exercise. Esomeprazole and rabeprazole should be the first-line choice from among the PPIs available at the Qatari government hospital health services.’
He added:
The health and wellness of the Qatari society is a key priority of QU’s research roadmap, we are ensuring that our research outcomes align with the needs of the fast-growing health care sector in Qatar, and contribute to providing efficient solutions to health challenges in the community.’
Dr Abdullatif Al Khal said:
Physicians in Qatar, both in the public and the private sector, face a dilemma when making a choice between the many available options to treat dyslipidemias or gastro-esophageal reflex disease. There are no specific protocols that tell physicians what the first choice should be. Such studies that are conducted jointly between the College of Pharmacy at QU and the clinical departments at HMC help greatly shed light on what are the best choices for our patients population based on locally developed and evidence based criteria. Similar studies addressing local relevance of prescribing practices are likely to prove valuable for the country.’
The study followed a research project entitled “Statin Selection in Qatar Based on Multi-indication Pharmacotherapeutic Multi-criteria Scoring Model, and Clinician Preference”, in which the team developed an evidence-based, multi-indication, and multi-criteria pharmacotherapeutic model for the scoring of statins at HMC. Outcome measures for multiple indications were related to effects on LDL cholesterol, HDL cholesterol, triglyceride, total cholesterol, and C-reactive protein. Atorvastatin, pravastatin, and rosuvastatin exceeded defined pharmacotherapeutic thresholds. Atorvastatin and pravastatin were recommended as first-line use and rosuvastatin as a non-formulary alternative, which can contribute to up to 40.1% cost savings in statins expenditure.
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