Goal

Determine education and skills needed for conducting evaluations, interpreting and using healthcare pharmacoeconomic evaluations in health care decisions.

Specific Objectives

• Describe basic knowledge and skills required for researchers
• Present the appropriate training methods (courses, workshops, academic certification, or in-house programs) for pharmacoeconomic researchers
• Suggest courses for degree programs
• Recommend next steps

Co-chairs

• Katie Copley-Merriman MS MBA, Director, Outcomes Research, Parke-Davis Pharmaceutical Research
  Gordon Vanscoy PharmD MBA, Vice President, Managed Clinical Division Stadtlander Drug Company Inc. and Assistant Dean, University of Pittsburgh

Panelists:

• David Angaran RPh MS,
• Sara Beis RPh MS, Medications Use Policy Pharmacist, Center for Drug Policy Analysis University of Wisconsin Hospitals & Clinics
• JoLaine Draugalis RPh PhD, Associate Professor & Assistant Dean, University of Arizona College of Pharmacy
• Deborah Freund PhD MPH, Vice Chancellor for Academic Affairs, Indiana University, James Pellissier PhD, Senior Biometrician, Merck Research Laboratories
• Richard Schulz PhD, Professor, University of South Carolina College of Pharmacy

Background and Context

Like other disciplines, to expand and grow as a mature area of research and application, the field of health economics requires experts and skilled professionals. Previous educational efforts by schools of pharmacy includes the 1993 Invitational Conference, the America College of Clinical Pharmacists Proposed Guidelines for Pharmacoeconomics Fellowships (ACCP) , and International Federation of Pharmaceutical Manufacturer Associations' Survey (IFPMA). Various published surveys have also been produced with respect to the teaching of health economics at the university level.

Unlike many other scientific fields, there is no one background or training that prepares the researcher or the user of health economic information, who currently come from a diversity of educational and experiential backgrounds. Because this can and often does lead to difficulties in attaining consistent and high quality research, and achieving optimal use of health economic information in decision-making, a standardization of the educational and skills requirements for health economics providers and users need to be determined.

Problem Statement

At the present time there is a strong demand for, and short supply of, qualified professionals in the field of health economics. The educational infrastructure is inadequate to satisfy the demand. Courses are not standardized and there is a shortage of adequately trained faculty members. Position variability and the multidisciplinary nature of the field make selection of qualified applicants with various backgrounds difficult for employers. Currently, a diversity of training opportunities exists for both decision-makers and researchers but there are few recognized formal programs. There is also a lack of awareness of available training opportunities.

Issues

The following key issues related to education and skills in the field of health economics were identified:

1. Multidisciplinary Programs

The structuring of multidisciplinary programs needs to be defined for people coming from a variety of backgrounds.

2. "Real-World" Applications

Training must include "real-world" applications.

3. Ideal Program

It is unlikely that an ideal program can be created in any one place within one institution or group without collaboration with others.

4. Minimal Competencies

The usefulness of minimal competencies in the field has to be determined. Minimal competencies will be different for current and future practitioners by depth of involvement. For each level of involvement, the type of competencies will have to be defined.

5. Who should be trained

Questions pertaining to who should be trained, how should training be performed and what level of training is required need to be answered.

6. Credentialing

The necessity of credentialing needs to be assessed.

7. Training Opportunities

There is need to improve the way information about training opportunities is disseminated.

A number of training opportunities specifically related to economic evaluations in health care already exist, including Self-study Continuing Education (CE) Programs, sponsored workshops and live CE programs. Certificate programs are also available. For example, the American Society of Health-System Pharmacists (ASHP) Competitive Edge Program which is society-sponsored includes self-study (30 hours), lecture and simulation exercises (4.5 days) and a research project (3-4 months). University-based certificate programs, undergraduate major degrees and minor concentrations exist in the field of health economics. Post-doctoral fellowships are also available. Various types of Master's Degrees (MS, MBA, MPH), medical training (MD) and doctoral training (PharmD, PhD) in a number of related disciplines also contribute significantly to existing training opportunities in health economics. Key Disciplines contributing to expertise in health economics are:

• Accounting
• Business
• Economics
• Engineering
• Environmental Forecasting
• Epidemiology
• Finance
• Health Administration
• Management Science
• Marketing
• Medicine
• Nursing
• Pharmacy
• Psychometrics
• Sociology
• Statistics/Biostatistics

Recommendations and Next Steps

Recommendations are proposed in the following domains:

1. Levels of expertise
2. Educational infrastructure awareness
3. Educational infrastructure enhancement
4. Proper training "match"
5. Balance between didactic and experiential education
6. Credentialing
7. Standardization of training and certification

1. Levels of Expertise

Three levels of expertise were identified by the panel including:

• Awareness
• Application
• Conceptualization

A list of these different levels of expertise is shown in Table 2. Awareness is defined as an exposure to and factual knowledge of the discipline, allowing trained individuals to converse and understand research data in the field. Individuals trained at the "application" level should be able to critically compare, evaluate and make decisions based on health economic research information. In addition, they should have the ability to initiate studies based on standard methodologies. For the conceptualization level of expertise, trained individuals would have the ability to create new methodology, develop theory and assimilate relevant methodologies and theories from related disciplines.

2. Educational infrastructure awareness

The panel recommends developing access to detailed information about available educational programs in the field of health economics. Identification of relevant educational resources outside of the field should be part of this awareness. A website would be an ideal tool to disseminate information on availability of all existing training programs.

3. Educational infrastructure enhancement

Relevant educational resources outside of health economics should be utilized to enhance the educational infrastructure. With respect to health economics training, a website and other available communication technologies should be used to offer educational support. This may include question-answer potential on-line and distance courses through a website. Sponsored formal training programs was also proposed. These would be competitively selected and targeted to different levels. The offering of higher level programs should be encouraged as well as short courses at society meetings and one to two-week training programs.

To assure relevance for all stakeholders, a three-way partnership with managed care, industry and academia needs to be established for fellowship and residency programs. There is also a need for official funding and faculty incentives. Nationally known training sites and "Train the trainer" programs would also contribute to the infrastructure.

The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) has a role to play in enhancing the educational infrastructure for health economics. Through ISPOR, various types of training could be offered, especially for those at higher levels. Faculty trainers should be experts in the field wherever possible. ISPOR may also wish to join forces with other organizations to expand programs.

4. Proper training "match"

Degree programs should accommodate multidisciplinary participants through the availability of prerequisite trainings and flexible core course offerings. Potential students of programs at the awareness training level should be made aware of their requirements. ISPOR identification of training programs would be helpful.

5. Balance between Didactic and Experiential Education

Programs, regardless of level, are enhanced by the incorporation of real-world data and exposure. The panel recommends that any training include working in a real-life setting, with case studies and "live" datasets. Establishment of collaborative relationships between academia, industry and managed care organizations would be necessary to allow optimal training experiences.

6. Credentialing of individuals

The development of a credentialing process should be a long-term goal of ISPOR to establish standards for the field. In the short term, for those already active in the field, the use of a professional portfolio demonstrating accomplishment in the field is recommended for credentialing of individuals.

7. Standards of training and certification

It is recommended that ISPOR plays a leadership role in standardizing training and certification through a three step process.

• Develop guidelines for post-professional degree training
• Accreditate pharmacoeconomic residencies and fellowships
• Establish collaborations with other organizations to expand accreditation to other relevant residencies

Summary

At the present time there is a strong demand for and short supply of qualified professionals in the field of health economics. Although a diversity of training opportunities exists for both decision-makers and researchers, the educational infrastructure is inadequate to satisfy the demand. Recognizing the need for different levels of expertise, the panel recommends an effort be made to increase awareness of currently available training opportunities and to strengthen the number and quality of these programs. Credentialing and standardization of training and certification are proposed as long term goals in which the International Society for Pharmacoeconomics and Outcomes Research has a major role to play.

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