National Drug Formulary review of statin therapeutic group using the multiattribute scoring tool

Ramli, Azuana, Aljunid, Syed M., Sulong, Saperi and Yusof, Faridah A., (2013). National Drug Formulary review of statin therapeutic group using the multiattribute scoring tool. Therapeutics and Clinical Risk Management, 9 491-504

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  • Sub-type Journal article
    Author Ramli, Azuana
    Aljunid, Syed M.
    Sulong, Saperi
    Yusof, Faridah A.
    Title National Drug Formulary review of statin therapeutic group using the multiattribute scoring tool
    Appearing in Therapeutics and Clinical Risk Management
    Volume 9
    Publication Date 2013-12-01
    Place of Publication n/a
    Publisher Dovepress
    Start page 491
    End page 504
    Language English
    Abstract Purpose: HMG-CoA reductase inhibitors (statins) are extensively used in treating hypercholesterolemia. The statins available in Malaysia include atorvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin, and fluvastatin. Over the years, they have accumulated in the National Drug Formulary; hence, the need for review. Effective selection of the best drugs to remain in the formulary can become complex due to the multiple drug attributes involved, and is made worse by the limited time and resources available. The multiattribute scoring tool (MAST) systematizes the evaluation of the drug attributes to facilitate the drug selection process. In this study, a MAST framework was developed to rank the statins based on their utilities or benefits. Methods: Published literature on multicriteria decision analysis (MCDA) were studied and five sessions of expert group discussions were conducted to build the MAST framework and to review the evidence. The attributes identified and selected for analysis were efficacy (clinical efficacy, clinical endpoints), safety (drug interactions, serious side effects and documentation), drug applicability (drug strength/formulation, indications, dose frequency, side effects, foodﾖdrug interactions, and dose adjustments), and cost. The average weights assigned by the members for efficacy, safety, drug applicability and cost were 32.6%, 26.2%, 24.1%, and 17.1%, respectively. The utility values of the attributes were scored based on the published evidence or/and agreements during the group discussions. The attribute scores were added up to provide the total utility score. Results: Using the MAST, the six statins under review were successfully scored and ranked. Atorvastatin scored the highest total utility score (TUS) of 84.48, followed by simvastatin (83.11). Atorvastatin and simvastatin scored consistently high, even before drug costs were included. The low scores on the side effects for atorvastatin were compensated for by the higher scores on the clinical endpoints resulting in a higher TUS for atorvastatin. Fluvastatin recorded the lowest TUS. Conclusion: The multiattribute scoring tool was successfully applied to organize decision variables in reviewing statins for the formulary. Based on the TUS, atorvastatin is recommended to remain in the formulary and be considered as first-line in the treatment of hypercholesterolemia.
    Keyword Multicriteria decision analysis
    Utility score
    Drug attributes
    Drug selection
    Copyright Holder Dove Medical Press Limited
    Copyright Year 2013
    Copyright type All rights reserved
    DOI 10.2147/TCRM.S52078
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    Created: Wed, 11 Jun 2014, 16:20:29 JST