FAQs
What do you mean by 'precision prescribing'?
Choosing the best drug for an individual patient, reducing the need for trying another drug when the one prescribed doesn't work or causes unacceptable side effects. DrugRanks provides the comparative information needed to tailor a prescription for a patient.
Choosing the best drug for an individual patient, reducing the need for trying another drug when the one prescribed doesn't work or causes unacceptable side effects. DrugRanks provides the comparative information needed to tailor a prescription for a patient.
Doesn’t the British National Formulary (BNF), which anyone can purchase, already do this?
Not really. Although it is an impressive and useful document, providing convenient summaries of individual drugs in the UK along with guidance on best practice, much of it from NICE and the MHRA, nearly everything is described in words.
There is hardly any numerical data about the magnitude and likelihood of favourable effects, or the severity and incidence of unfavourable effects. Few data tables and no graphical summaries are given, forcing users to trawl through an often-considerable amount of text before deciding.
Isn’t information about individual drugs sufficient for most clinical interventions?
Yes, in deciding the approach to take for a given patient, but not necessarily which drug to prescribe. For example, in the section on antidepressant drugs, the BNF points out that ‘SSRIs are better tolerated and are safer in overdose than other classes of antidepressants and should be considered first-line for treating depression’. In the section on SSRIs, a page of general comments is followed by descriptions of six non-proprietary drugs, but there is no comparative assessment of the six.
What would a comparative assessment add?
First, an ordering of the drugs based on their overall benefit-risk balances, second, the benefit-risk profile of each drug accompanied by graphs that aid interpretation; and third, an Effects Table showing the definitions of all the effects, the input data and the relative importance weights assigned to each of the effects.
How would that assist decision making?
The benefit-risk profiles of available drugs identify the favourable and unfavourable effects that are characteristic of each drug, which enable decisions that are clinically relevant for an individual patient.
The tables and graphs enable quick comparative survey of the alternatives. The Effects Table provides decision makers with the evidence, the favourable and unfavourable effects, enabling them to apply with confidence their own clinical judgements in making a decision and providing advice about trade-offs.
Why aren't costs considered?
Because there are no 'true' costs for a given drug. The British National Formulary only give costs for a single dose or multiple doses. However, the costs for a maximum daily dose for some over-the-counter pain-killers were higher than the purchase price offered to shoppers at some UK supermarkets. Costs can also differ across different regions or countries, while the benefit-safety profile may remain unchanged.
Other sources quote costs for a fixed time, like the maximum time for which the drug should be taken. In some cases the total costs for a single time period are given. For example, one source lists costs for a year's treatment of overactive bladder drugs, without regard for the average number days of actual treatment.
If treatment costs could be established, the benefit-safety figure for a drug should be divided by the treatment cost to give a value-for-money figure known as a Performance Index. That might result in a useful but different ordering of the drugs. It is, of course, the task of Health Technology Assessment organisations, like the UK's NICE, to determine costs of treatment. DrugRanks results might be of interest to HTA organisations.
What can DrugRanks contribute to better public health?
Not really. Although it is an impressive and useful document, providing convenient summaries of individual drugs in the UK along with guidance on best practice, much of it from NICE and the MHRA, nearly everything is described in words.
There is hardly any numerical data about the magnitude and likelihood of favourable effects, or the severity and incidence of unfavourable effects. Few data tables and no graphical summaries are given, forcing users to trawl through an often-considerable amount of text before deciding.
Isn’t information about individual drugs sufficient for most clinical interventions?
Yes, in deciding the approach to take for a given patient, but not necessarily which drug to prescribe. For example, in the section on antidepressant drugs, the BNF points out that ‘SSRIs are better tolerated and are safer in overdose than other classes of antidepressants and should be considered first-line for treating depression’. In the section on SSRIs, a page of general comments is followed by descriptions of six non-proprietary drugs, but there is no comparative assessment of the six.
What would a comparative assessment add?
First, an ordering of the drugs based on their overall benefit-risk balances, second, the benefit-risk profile of each drug accompanied by graphs that aid interpretation; and third, an Effects Table showing the definitions of all the effects, the input data and the relative importance weights assigned to each of the effects.
How would that assist decision making?
The benefit-risk profiles of available drugs identify the favourable and unfavourable effects that are characteristic of each drug, which enable decisions that are clinically relevant for an individual patient.
The tables and graphs enable quick comparative survey of the alternatives. The Effects Table provides decision makers with the evidence, the favourable and unfavourable effects, enabling them to apply with confidence their own clinical judgements in making a decision and providing advice about trade-offs.
Why aren't costs considered?
Because there are no 'true' costs for a given drug. The British National Formulary only give costs for a single dose or multiple doses. However, the costs for a maximum daily dose for some over-the-counter pain-killers were higher than the purchase price offered to shoppers at some UK supermarkets. Costs can also differ across different regions or countries, while the benefit-safety profile may remain unchanged.
Other sources quote costs for a fixed time, like the maximum time for which the drug should be taken. In some cases the total costs for a single time period are given. For example, one source lists costs for a year's treatment of overactive bladder drugs, without regard for the average number days of actual treatment.
If treatment costs could be established, the benefit-safety figure for a drug should be divided by the treatment cost to give a value-for-money figure known as a Performance Index. That might result in a useful but different ordering of the drugs. It is, of course, the task of Health Technology Assessment organisations, like the UK's NICE, to determine costs of treatment. DrugRanks results might be of interest to HTA organisations.
What can DrugRanks contribute to better public health?
- Enable prescribers to choose quickly a drug that is high in benefits and safety, providing possible cost savings at no loss in effectiveness.
- Provide patients with non-technical descriptions describing the benefits and harms of each drug, and with evidence of expected benefits and side-effects so they can consider the trade-off between favourable and unfavourable effects.
- Provide joint formulary committees with the information needed to create stocks of drugs that are based on hard comparative evidence and the judgements of experts and clinicians.
- Speed up drug development in pharmaceutical companies by their using a CBSAD model to test the benefit-risk balance of a drug under development compared to similar marketed drugs, possibly helping to allocate its limited resources to more promising opportunities.
- Show how a newly approved drug fares compared to previous drugs ranked by DrugRanks. There is no need to redo the model; DrugRanks adds the new data required for its approval, as reported in the European Public Assessment Report, and the new drug will take its place compared to others for the same medical condition.
- Speed up approval of a drug that is currently being fast-tracked by a regulator if the new drug is incorporated into an existing DrugRanks model to determine its relative benefit-safety balance.