Evaluation of angiotensin II receptor blockers for drug formulary using objective scoring analytical tool

Main Article Content

Lim M. Tsuey
Mohamed I. Ibrahim



Drug selection methods with scores have been developed and used worldwide for formulary purposes. These tools focus on the way in which the products are differentiated from each other within the same therapeutic class. Scoring Analytical Tool (SAT) is designed based on the same principle with score and is able to assist formulary committee members in evaluating drugs either to add or delete in a more structured, consistent and reproducible manner.

Objective: To develop an objective SAT to facilitate evaluation of drug selection for formulary listing purposes.

Methods: A cross-sectional survey was carried out. The proposed SAT was developed to evaluate the drugs according to pre-set criteria and sub-criteria that were matched to the diseases concerned and scores were then assigned based on their relative importance. The main criteria under consideration were safety, quality, cost and efficacy. All these were converted to questionnaires format. Data and information were collected through self-administered questionnaires that were distributed to medical doctors and specialists from the established public hospitals. A convenient sample of 167 doctors (specialists and non-specialists) were taken from various disciplines in the outpatient clinics such as Medical, Nephrology and Cardiology units who prescribed ARBs hypertensive drugs to patients. They were given a duration of 4 weeks to answer the questionnaires at their convenience. One way ANOVA, Kruskal Wallis and post hoc comparison tests were carried out at alpha level 0.05.

Results: Statistical analysis showed that the descending order of ARBs preference was Telmisartan or Irbesartan or Losartan, Valsartan or Candesartan, Olmesartan and lastly Eprosartan. The most cost saving ARBs for hypertension in public hospitals was Irbesartan.

Conclusion: SAT is a tool which can be used to reduce the number of drugs and retained the most therapeutically appropriate drugs in the formulary, to determine most cost saving drugs and has the potential to complement the conventional method of drug selection as it is effective in aiding decision making process through the pre-established criteria and increasing scientific ground of decisions and transparency.

Abstract 1028 | PDF Downloads 769


1. Savelli A. Schwarz H, Zagorski A, Bykov A. Manual for the Development and Maintenance of Hospital Drug Formularies. 1996; [Accessed 12th April 2008]. Available from: http://erc.msh.org/newpages/english/dmpmodule/formul_en.pdf

2. Duerden M, Walley T. Prescribing at the interface between primary and secondary care in the UK. Towards joint formularies? Pharmacoeconomics. 1999;15(5):435-443.

3. Avery A, Walker B, Murphy E. Overcoming obstacles in formulary development. Prescriber. 2003;8(8):27.

4. Karr A. The Comparative Utilisation of Resources Evaluation Model-a CURE for all disease. Pharm J. 2000; 265(7119):610-621.

5. Janknegt R, Steenhoek A. The System of Objectified Judgment Analysis (SOJA): a tool in rational drug selection for formulary inclusion. Drugs. 1997; 53(4):550-562.

6. Karr A. Improving the drug evaluation process. Pharm J 1994;252:576-577.

7. Conlin PR, Spence JD, Williams B, Ribeiro AB, Saito I, Benedict C, Bunt AM. Angiotensin II antagonists for hypertension: are there differences in efficacy? Am J Hypertens. 2000;13(4 Pt 1):418-426.

8. British National Formulary. No 55. London: British Medical Association/Royal Pharmaceutical Society of Great Britain. March, 2008.

9. Shosteck H, Fairweather WR. Physician response rates to mail and personal interview surveys Public Opin Q. 1979;43(2):206-217.

10. Sudman S. Mailed Survey of reluctant professionals. Eval Rev 1985;9(3):349-360.

11. Holbrook, Allyson, Jon Krosnick & Alison Pfent (2007). The Causes and Consequences of Response Rates in Surveys by the News Media and Government Contractor Survey Research Firms. In Advances in telephone survey methodology, ed. James M. Lepkowski, N. Clyde Tucker, J. Michael Brick, Edith D. De Leeuw, Lilli Japec, Paul J. Lavrakas, Michael W. Link, and Roberta L. Sangster. New York: Wiley.

12. Response Rates – An Overview. American Association for Public Opinion Research (AAPOR). 29 Sept 2008.

13. Kellerman SE, Herold J. Physician response to surveys. A review of the literature. Am J Prev Med. 2001;20(1):61-67.

14. Bjertnaes OA, Garratt A, Botten G.. Nonresponse Bias and Cost Effectiveness in awegian Survey of Family Physicians. Eval Health Prof. 2008;31(1):65-80.

15. McFarlane E, Olmsted MG, Murphy J, Hill CA. Nonresponse Bias in a Mail Survey of Physicians. Eval Health Prof. 2007;30(2):170-185.

16. Menachemi N, Hikmet N, Stutzman M, Brooks RG.. Investigating response bias in an information technology survey of physicians. J Med Syst. 2006;30(4):277-282.

17. Dickstein K, Kjekshus J; OPTIMAAL Steering Committee of the OPTIMAAL Study Group. Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial. Optimal Trial in Myocardial Infarction with Angiotensin II Antagonist Losartan.. Lancet. 2002;360(9335):752-760.

18. Dahlöf B, Devereux RB, Kjeldsen SE, Julius S, Beevers G, de Faire U, Fyhrquist F, Ibsen H, Kristiansson K, Lederballe-Pedersen O, Lindholm LH, Nieminen MS, Omvik P, Oparil S, Wedel H; LIFE Study Group. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol.. Lancet. 2002;359(9311):995-1003.

19. Weir CJ, Muir SW, Walters MR, Lees KR. Serum urate as an independent predictor of poor outcome and future vascular events after acute stroke. Stroke. 2003;34(8):1951-1956.

20. Minghelli G, Seudoux C, Goy JJ, Burnier M. Uricosuric effect of the angiotensin II receptor antagonist losartan in heart transplant recipients. Transplantation. 1998;66(2):268-271.

21. Holloway K, Green T. Drug and Therapeutics Committees: A Practical Guide. Geneva, Switzerland: World Health Organization; 2003.

22. Cohn JN. Improving outcomes in congestive heart failure: Val-HeFT. Valsartan in Heart Failure Trial. Cardiology. 1999;91(Suppl 1):19-22.

23. Pfeffer MA, McMurray J, Leizorovicz A, Maggioni AP, Rouleau JL, Van De Werf F, Henis M, Neuhart E, Gallo P, Edwards S, Sellers MA, Velazquez E, Califf R. Valsartan in Acute Myocardial Infraction Trial (VALIANT): rationale and design. Am Heart J. 2000;140(5):727-750.

24. Young JB, Dunlap ME, Pfeffer MA, Probstfield JL, Cohen-Solal A, Dietz R, Granger CB, Hradec J, Kuch J, McKelvie RS, McMurray JJ, Michelson EL, Olofsson B, Ostergren J, Held P, Solomon SD, Yusuf S, Swedberg K; Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM) Investigators and Committees. Mortality and morbidity reduction with Candesartan in patients with chronic heart failure and left ventricular systolic dysfunction: results of the CHARM low left ventricular ejection fraction trials. Circulation. 2004;110(17):2618-2626.

Most read articles by the same author(s)

1 2 > >>