[2026-09-30] Development of Criteria for Selecting Medicines for Hospital Formulary Using Efficiency-to-Cost Evaluation
DOI:
https://doi.org/10.33165/rmj.2027.e280368Keywords:
Hospital formulary, Price-performance, Efficiency-to-cost, Delphi technique, Pharmaceutical procurementAbstract
Background: Transparent and value-based medicine selection is essential for hospital formulary management under Thailand’s public procurement regulations. Price-focused approaches may not adequately capture medicine quality, clinical value, and system constraints.
Objectives: To develop and validate criteria for selecting medicines for a hospital formulary using efficiency-to-cost (price-performance) evaluation through the Delphi technique.
Methods: A modified 2-round Delphi process was conducted with an interdisciplinary expert panel comprising pharmacists and clinicians. An initial set of criteria was derived from a structured literature review, national procurement regulations, and standard hospital practices. Experts rated each criterion for importance and relevance using a 5-point Likert scale over 2 rounds of iterative Delphi process. Consensus was assessed using median scores and interquartile ranges (IQR). Usability and acceptance of the finalized criteria were evaluated using the System Usability Scale (SUS).
Results: Consensus was achieved after 2 rounds of Delphi process. The initial 46 criteria were refined to a final set of 20 criteria organized into 3 policy-relevant domains: price-performance ratio, quality and attributes beneficial to government policy, and other beneficial qualifications. All items retained for consolidation demonstrated high importance (median ≥ 4.5) and strong agreement (IQR < 1.0). The mean SUS score was 62.25, indicating fair usability and moderate acceptance of the criteria, highlighting the need for operational simplification prior to routine procurement decision-making.
Conclusions: Delphi-derived efficiency-to-cost criteria provide a transparent, structured framework for hospital formulary selection, enhancing value for money. To ensure widespread adoption, operational processes must be streamlined via digital integration and real-world piloting across diverse procurement settings.
References
Ministry of Finance. Public Procurement and Supplies Administration Act B.E. 2560 (2017). Royal Thai Government Gazette. 2017;134(24A):13-54. Accessed 6 July 2026. https://www.nia.or.th/law_procurement.html
Vogler S, Paris V, Panteli D. Ensuring Access to Medicines: How to Redesign Pricing, Reimbursement and Procurement? (Policy Brief, No. 30). European Observatory on Health Systems and Policies; 2018. Accessed 6 July 2026. https://iris.who.int/server/api/core/bitstreams/0f08d281-0add-49bb-9ee0-b31571667af6/content
World Health Organization. Operational Principles for Good Pharmaceutical Procurement. World Health Organization; 1999. Accessed 6 July 2026. https://iris.who.int/handle/10665/66251
Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes. 4th ed. Oxford University Press; 2015. Accessed 6 July 2026. https://nibmehub.com/opac-service/pdf/read/Methods%20for%20the%20Economic%20Evaluation%20of%20Health%20Care%20Programmes.pdf
Management Sciences for Health. MDS-3: Managing Access to Medicines and Health Technologies. Management Sciences for Health; 2012. Accessed 6 July 2026. https://msh.org/wp-content/uploads/2013/04/mds3-fm-revised-nov2012.pdf
Office of the Permanent Secretary, Ministry of Public Health Guideline for Defining Drug Specifications. Ministry of Public Health; 2016. Accessed 6 July 2026. https://dmsic.moph.go.th/upload/web_download/drugspecguideline_2559_20160706_220901.pdf
Hsu CC, Sandford BA. The Delphi technique: making sense of consensus. Pract Assess Res Eval. 2007;12(10):1-8.
Rowe G, Wright G. The Delphi technique as a forecasting tool: issues and analysis. Int J Forecast. 1999;15(4):353-375. doi:10.1016/S0169-2070(99)00018-7
Diamond IR, Grant RC, Feldman BM, et al. Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol. 2014;67(4):401-409. doi:10.1016/j.jclinepi.2013.12.002
Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. 2000;32(4):1008-1015. doi:10.1046/j.1365-2648.2000.t01-1-01567.x
Brooke J. SUS: A 'Quick and Dirty' Usability Scale. In: Jordan PW, Thomas B, McClelland IL, Weerdmeester B, eds. Usability Evaluation In Industry. CRC Press; 1996. doi:10.1201/9781498710411
Bangor A, Kortum PT, Miller JT. An empirical evaluation of the System Usability Scale. Int J Hum Comput Interact. 2008;24(6):574-594. doi:10.1080/10447310802205776
Sauro J, Lewis JR. Quantifying the User Experience: Practical Statistics for User Research. Morgan Kaufmann; 2012.
Reich MR. Essential drugs: economics and politics in international health. Health Policy. 1987;8(1):39-57. doi:10.1016/0168-8510(87)90129-1
Chang S, Wong JW, Wong CW, Chiu HC, Raymond K. Overview of the hospital formulary systems in Hong Kong. Princess Margaret Hospital as a baseline. Ann Pharmacother. 1997;31(12):1526-1531. doi:10.1177/106002809703101214
Beilby JJ, Silagy CA. Trials of providing costing information to general practitioners: a systematic review. Med J Aust. 1997;167(2):89-92. doi:10.5694/j.1326-5377.1997.tb138787.x
Alabbadi I, Crealey G, Scott M, et al. Impact of modified system of objectified judgement analysis (SOJA) methodology on prescribing costs of ACE inhibitors. Clin Drug Investig. 2006;26(9):485-494. doi:10.2165/00044011-200626090-00001
Jirawattanapisal T, Kingkaew P, Lee TJ, Yang MC. Evidence-based decision-making in Asia-Pacific with rapidly changing health-care systems: Thailand, South Korea, and Taiwan. Value Health. 2009;12 Suppl 3:S4-S11. doi:10.1111/j.1524-4733.2009.00620.x
Gallini A, Juillard-Condat B, Saux MC, Taboulet F. Drug selection in French university hospitals: analysis of formularies for nine competitive pharmacological classes. Br J Clin Pharmacol. 2011;72(5):823-831. doi:10.1111/j.1365-2125.2011.03997.x
Lim TM, Ibrahim MI. Evaluation of angiotensin II receptor blockers for drug formulary using objective Scoring Analytical Tool. Pharm Pract. 2012;10(3):136-142. doi:10.4321/s1886-36552012000300003
Lim L, Mohamed Izham MI. Selection of proton pump inhibitors (PPIs) for formulary inclusion using an objective scoring system in Malaysia. J Appl Pharm Sci. 2012;2(3):17-24. doi:10.7324/JAPS.2012.2304
Lafi R, Robinson S, Williams I. Economic evaluation and the Jordan Rational Drug List: an exploratory study of national-level priority setting. Value Health. 2012;15(5):771-776. doi:10.1016/j.jval.2012.04.006
Yoongthong W, Hu S, Whitty JA, et al. National drug policies to local formulary decisions in Thailand, China, and Australia: drug listing changes and opportunities. Value Health. 2012;15(1 Suppl):S126-S131. doi:10.1016/j.jval.2011.11.003
Seigfried RJ, Corbo T, Saltzberg MT, Reitz J, Bennett DA. Deciding which drugs get onto the formulary: a value-based approach. Value Health. 2013;16(5):901-906. doi:10.1016/j.jval.2013.03.1623
Ríos PR, Rivera AG, Oropeza IR, Ramírez OC. The update of the Mexican Health Care Formulary and Supply Catalog in the context of the health technology assessment. Value Health Reg Issues. 2014;5:29-34. doi:10.1016/j.vhri.2014.08.002
Akhmadyar NS, Khairulin BE, Amangeldy-Kyzy S, Ospanov MA. Developing drug formularies for the "National Medical Holding" JSC. Int J Risk Saf Med. 2015;27 Suppl 1:S51-S52. doi:10.3233/JRS-150686
Ortega A, Fraga MD, Marín-Gil R, Lopez-Briz E, Puigventós F, Dranitsaris G. Economic evaluation in collaborative hospital drug evaluation reports. Farm Hosp. 2015;39(5):288-296. doi:10.7399/fh.2015.39.5.9361
Rashidian A, Omidvari AH, Vali Y, Sturm H, Oxman AD. Pharmaceutical policies: effects of financial incentives for prescribers. Cochrane Database Syst Rev. 2015;2015(8):CD006731. doi:10.1002/14651858.CD006731.pub2
Al-Badriyeh D, Fahey M, Alabbadi I, Al-Khal A, Zaidan M. Statin selection in Qatar based on multi-indication pharmacotherapeutic multi-criteria scoring model, and clinician preference. Clin Ther. 2015;37(12):2798-2810. doi:10.1016/j.clinthera.2015.07.020
Al-Badriyeh D, Alabbadi I, Fahey M, Al-Khal A, Zaidan M. Multi-indication pharmacotherapeutic multicriteria decision analytic model for the comparative formulary inclusion of proton pump inhibitors in Qatar. Clin Ther. 2016;38(5):1158-1173. doi:10.1016/j.clinthera.2016.03.004
Lekkanok J. Outcomes of pharmaceutical medicines procurement by electronic bidding at a middle-level (M2) hospital. Thai J Hosp Pharm. 2019;29(3):203-215.
Barbier L, Vandenplas Y, Boone N, Huys I, Janknegt R, Vulto AG. How to select a best-value biological medicine? a practical model to support hospital pharmacists. Am J Health Syst Pharm. 2022;79(22):2001-2011. doi:10.1093/ajhp/zxac235
Jamroenkajornsuk P, Cheawchanwattana A. Forecasting the amount of drug procurement: a case study of a community hospital. Thai J Pharm Pract. 2022;14(3):770-778.
Koushki MS, Goudarzi R, Amiresmaili M, Nekooei Moghaddam M, Yazdi-Feyzabadi V, Talebian A. Strategies of drugs cost containment in hospital: a systematic literature review. Int J Health Plann Manage. 2023;38(1):7-21. doi:10.1002/hpm.3542
Ngan Kee N, Foster E, Marquina C, et al. Systematic review of cost-effectiveness analysis for surgical and neurostimulation treatments for drug-resistant epilepsy in adults. Neurology. 2023;100(18):e1866-e1877. doi:10.1212/WNL.0000000000207137
Zimbwe KB, Kizenga OS, Francis EN, Yona YJ, Yahya TA. Medicine formulary writing for hospitals: a systematic review on development, approval, dissemination, and review. Pharm Educ. 2024;24(1):186-199. doi:10.46542/pe.2024.241.186199
Hayati EN, Jauhari WA, Damayanti RW, Rosyidi CN. An integrated analytics model for supplier selection and order allocation with machine learning and multi-criteria optimization. Decis Anal J. 2025;16:100599. doi:10.1016/j.dajour.2025.100599
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 by the Author(s). Licensee RMJ.
This work is licensed under a Creative Commons Attribution 4.0 International License.
