Drug use evaluation. Contributions to quality assurance and cost-containment

Over the past 20 years, drug use review (DUR) activities have become an integral component of inpatient care to assure that medications are being used in the most cost-effective manner. The term drug use evaluation (DUE) has supplanted DUR, because DUE implies an expansive, integrated program that includes retrospective, concurrent, and prospective drug performance evaluations made possible through automation. DUE monitors drug experience outcomes, which allows the Pharmacy & Therapeutics (P&T) Committee to revise the drug formulary in response to patient care and cost-analysis research. Computerized HMOs are now embracing DUE as a result of the competitive drive to balance quality of care and cost-containment. United HealthCare (UHC) has used DUE to evaluate the cost-effectiveness of therapeutically similar medications. The UHC database captures medical and pharmacy claims data, and allows analysis of the total cost of care. UHC has used the system to make rational formulary decisions based on global costs, rather than drug ingredient costs. As data processing systems such as this flourish, other HMOs will be able to conduct similar DUE activities. The HMO environment provides a fertile site for such research to be conducted by pharmaceutical manufacturers.