Formulary Question

Imagine that you are one of the pharmacists making formulary decisions at a medical center. A new hematologist has moved to your medical center. She is one of the nation’s best known experts on paroxysmal nocturnal hemoglobinuria (PNH).  She has been treating quite a few patients with eculizumab.   Eculizumab is FDA-approved for treatment of hemolysis in PNH, but not all of the hematologist’s eculizumab-treated PNH patients require treatment for hemolysis.  Some require treatment because of significant thrombotic complications.

The pharmacy doesn’t have much experience with eculizumab which is one of the most expensive drugs in the world,  at about $700,000/year of therapy.  They would like you to prepare a formulary monograph on use of eculizumab in PNH with thrombosis.  You decide to start by looking for randomized controlled trials.

Search step 1.  Outline the search concept

The first step in any literature search is outlining the search concepts.