Cargando…
Verifying the value of existing frameworks for formulary review at a large academic health system: assessing inter-rater reliability
BACKGROUND: 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 medication...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Academy of Managed Care Pharmacy
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10391159/ https://www.ncbi.nlm.nih.gov/pubmed/33769852 http://dx.doi.org/10.18553/jmcp.2021.27.4.488 |
_version_ | 1785082641096114176 |
---|---|
author | Karas, Brittany Lee Picone, Mary Frances Werner, Shannon Holsopple, Megan |
author_facet | Karas, Brittany Lee Picone, Mary Frances Werner, Shannon Holsopple, Megan |
author_sort | Karas, Brittany Lee |
collection | PubMed |
description | BACKGROUND: 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. OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. |
format | Online Article Text |
id | pubmed-10391159 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Academy of Managed Care Pharmacy |
record_format | MEDLINE/PubMed |
spelling | pubmed-103911592023-08-02 Verifying the value of existing frameworks for formulary review at a large academic health system: assessing inter-rater reliability Karas, Brittany Lee Picone, Mary Frances Werner, Shannon Holsopple, Megan J Manag Care Spec Pharm Research BACKGROUND: 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. OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. Academy of Managed Care Pharmacy 2021-04 /pmc/articles/PMC10391159/ /pubmed/33769852 http://dx.doi.org/10.18553/jmcp.2021.27.4.488 Text en Copyright © 2021, Academy of Managed Care Pharmacy. All rights reserved. https://creativecommons.org/licenses/by/4.0/This article is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use and redistribution provided that the original author and source are credited. |
spellingShingle | Research Karas, Brittany Lee Picone, Mary Frances Werner, Shannon Holsopple, Megan Verifying the value of existing frameworks for formulary review at a large academic health system: assessing inter-rater reliability |
title | Verifying the value of existing frameworks for formulary review at a large academic health system: assessing inter-rater reliability |
title_full | Verifying the value of existing frameworks for formulary review at a large academic health system: assessing inter-rater reliability |
title_fullStr | Verifying the value of existing frameworks for formulary review at a large academic health system: assessing inter-rater reliability |
title_full_unstemmed | Verifying the value of existing frameworks for formulary review at a large academic health system: assessing inter-rater reliability |
title_short | Verifying the value of existing frameworks for formulary review at a large academic health system: assessing inter-rater reliability |
title_sort | verifying the value of existing frameworks for formulary review at a large academic health system: assessing inter-rater reliability |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10391159/ https://www.ncbi.nlm.nih.gov/pubmed/33769852 http://dx.doi.org/10.18553/jmcp.2021.27.4.488 |
work_keys_str_mv | AT karasbrittanylee verifyingthevalueofexistingframeworksforformularyreviewatalargeacademichealthsystemassessinginterraterreliability AT piconemaryfrances verifyingthevalueofexistingframeworksforformularyreviewatalargeacademichealthsystemassessinginterraterreliability AT wernershannon verifyingthevalueofexistingframeworksforformularyreviewatalargeacademichealthsystemassessinginterraterreliability AT holsopplemegan verifyingthevalueofexistingframeworksforformularyreviewatalargeacademichealthsystemassessinginterraterreliability |