Economic evaluations of drug therapy: attitudes of primary care prescribing advisers in Great Britain.
All health authorities in Great Britain have both medically or pharmaceutical qualified staff to advise both the authority and the local primary care medical practitioners about drug use and prescribing. This study used a piloted postal questionnaire to assess the attitudes of these advisers to economic evaluations of drug therapy, and their perceptions of the barriers to achieving cost effective prescribing by use of these evaluations. There was a 65% response rate to the questionnaire. Economic issues were rated by advisers to be less important than clinical issues, but were considered at most meetings between advisers and primary care medical practitioners. Advisers wished to consider true cost effective prescribing but often felt obliged to consider drug acquisition costs and risks of budgetary overspends. The perceived inflexibility of existing structures within the British National Health Service and the lack of credibility of the evaluations (often perceived as pharmaceutical industry marketing) were the major barriers to the application of the evaluations. The paper concludes that advisers were keen to use economic evaluations to promote cost effective prescribing but were impeded by the perceived bias of existing studies and by rigid current NHS structures.