[2026-09-30] Development of Criteria for Selecting Medicines for Hospital Formulary Using Efficiency-to-Cost Evaluation

Abstract

Background: Transparent and value-based medicine selection is essential for hospital formulary management under Thailand’s public procurement regulations. Price-focused approaches may not adequately capture medicine quality, clinical value, and system constraints. Objectives: To develop and validate criteria for selecting medicines for a hospital formulary using efficiency-to-cost (price-performance) evaluation through the Delphi technique. Methods: A modified 2-round Delphi process was conducted with an interdisciplinary expert panel comprising pharmacists and clinicians. An initial set of criteria was derived from a structured literature review, national procurement regulations, and standard hospital practices. Experts rated each criterion for importance and relevance using a 5-point Likert scale over 2 rounds of iterative Delphi process. Consensus was assessed using median scores and interquartile ranges (IQR). Usability and acceptance of the finalized criteria were evaluated using the System Usability Scale (SUS). Results: Consensus was achieved after 2 rounds of Delphi process. The initial 46 criteria were refined to a final set of 20 criteria organized into 3 policy-relevant domains: price-performance ratio, quality and attributes beneficial to government policy, and other beneficial qualifications. All items retained for consolidation demonstrated high importance (median ≥ 4.5) and strong agreement (IQR < 1.0). The mean SUS score was 62.25, indicating fair usability and moderate acceptance of the criteria, highlighting the need for operational simplification prior to routine procurement decision-making. Conclusions: Delphi-derived efficiency-to-cost criteria provide a transparent, structured framework for hospital formulary selection, enhancing value for money. To ensure widespread adoption, operational processes must be streamlined via digital integration and real-world piloting across diverse procurement settings.