A Guideline for the Use of Pharmacoeconomic Models of Diabetes Treatment in the US Managed-Care Environment

Background: The Academy of Managed Care Pharmacy has recently created guidelines for the submission of pharmacoeconomic models. Although these guidelines provide a general framework for the integration of pharmacoeconomic models in the drug selection process, amore disease-specific and practical ‘hands-on’ approach is needed for pharmacy staff and Pharmacy and Therapeutics (P&T) committee members. Objective: To answer the question, ‘How can pharmacoeconomic models comparing treatments for diabetes and its complications be evaluated and used to make more informed formulary decisions?’ Methods: We determined the information needs of a managed care organisation (MCO) making coverage decisions for diabetes therapies and reviewed current guidelines for the submission of pharmacoeconomic models to MCOs. We then developed a set of practical questions for evaluating models of diabetes treatment in a managed-care environment. Results: Information needed by P&T committees in relation to new diabetes medications includes the long-term benefits of reduced micro- and macrovascular complications and changes in drug utilisation patterns, in addition to the immediate drug budget impact. Because diabetes is a complex disease, the peer-review process should be relied on as a first step to help ensure the validity of a model. Then, the end-user of a model should evaluate (i) the sources of data to inform the model, (ii) the generalisability of the model for an MCO population, and (iii) the face validity of the assumptions of the model. Conclusion: Pharmacoeconomic models in diabetes offer potential for assisting P&T committee members in making more informed decisions. The guidelines presented here provide a practical approach for model assessment. However, additional expertise will be needed by MCOs to appropriately evaluate these models, and joint educational programmes between managed care, academia, and industry should be considered as a mechanism for improving technology assessment in diabetes care.