Cost is driver behind antibiotic inclusion in hospital formularies

Costs related to antibiotics are the most important factors influencing hospital formulary decision-making, according to a new report.

The top three factors influencing hospital formularies, according to Arlington Medical Resources, are antibiotic cost-related attributes such as drug price and administration cost, pathogen coverage, and efficacy.

Activity against drug-resistant Gram-negative (GN) pathogens leads all other drug attributes associated with pathogen coverage among the pharmacy and therapeutics (P&T) committee members surveyed for the report, “Hospital Formulary Insights: Anti-Infectives (US) 2013.”

“This finding is consistent with the increasing prevalence of drug-resistant GN infections and with the high unmet need for new therapies against these drug-resistant pathogens,” noted a statement from Arlington Medical Resources.

However, despite the availability of several effective anti-methicillin-resistant Staphylococcus aureus therapies, hospital pharmacy directors still consider activity against this pathogen to be an important driver of formulary selections.

The majority of P&T committee members surveyed say they are including Forest's Teflaro and Optimer's Dificid in their hospital formularies. However, prescribing of these agents is typically restricted. For antibiotics in development, most P&T members anticipate adding Cubist/Bayer's tedizolid to their hospital's formulary with restrictions, if approved by the FDA and priced similarly to linezolid.

"Our research suggests that the generic availability of linezolid is going to be a formidable challenge to tedizolid's formulary uptake, as cost-conscious P&T committees seek to minimize expenditures and perceived formulary redundancies," said Brenda Perez-Cheeks, PhD, Director of Infectious Diseases, Arlington Medical Resources. "However, focusing tedizolid messaging on areas where surveyed P&T committee members deem tedizolid to have important advantages over linezolid could encourage its placement on formularies and drive uptake."