Hospital pharmacy directors and competing optima: An evaluation of the importance of cost-effectiveness versus acquisition price

Cost containment pressures and the financial crisis facing many hospitals in the United States have brought concern about the cost of care to the forefront of health care policy debates. Hospital pharmacy budgets, as an easily identified component of hospital costs, have received a considerable amount of attention from hospital administrators and academic researchers alike. Pharmacoeconomic outcomes studies have been undertaken to identify the effect of the use of pharmaceutical agents on the total cost of delivering care, and many pharmacy directors have indicated their willingness, and that of the hospital's administration, to consider the total cost effect of a medication over its acquisition cost. Yet most discussions of formulary decision making focus exclusively on questions of acquisition cost and pharmacy-specific cost implications.;This study sought to determine the degree to which the price, and direct pharmacy cost implications, of a hypothetical new agent would offset the potential pharmacoeconomic benefits of a product that has the ability to reduce costs outside of the pharmacy (i.e. in other areas of the hospital).;Questionnaires were mailed to 1753 hospital pharmacy directors, who were asked to report on activities meant to control drug use within their institution and evaluate a hypothetical new drug. Using a monadic design, the sample was broken into three groups, each exposed to a different acquisition for the agent (;A total of 548 responses were received (31.3%) and 353 were found to be usable (20.1%). This reduction in usable responses was due to the need to limit the final sample to those institutions that performed surgical repairs of peripheral arterial occlusions, the disorder that the hypothetical drug would treat.;One-way analysis of variance (p =.042) revealed that those pharmacy directors exposed to the highest price (;These findings suggest that for a significant proportion of hospital pharmacy directors, the acquisition price of a new drug and its subsequent effect on the pharmacy budget, regardless of the potential for the agent to render significant savings in total hospital costs, will cause them to take actions to resist the adoption of the agent. This decision appears to be based in large part on the practice of tying a portion of the pharmacy director's compensation to his or her ability to control drug expenditures.