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The purpose of this study was to reassess the graduate pharmacoeconomic and outcomes research educational program offerings nationwide, estimate enrollment and completion figures, and determine the placement of recent graduates. An eleven-item questionnaire was completed by one faculty member at the 41 U.S. schools and colleges of pharmacy housing a social and administrative sciences graduate program for a 100 percent response rate. In five years, numbers have increased from 92 participants at 18 institutions with 18 anticipated completions to 317 enrollees at 35 institutions with 86 expected completions for academic year 1998-1999. Fellows were most apt to secure an industry post upon program completion, MS graduates tended to continue their studies, and PhD graduates were most apt to accept a position either in the pharmaceutical industry or an academic institution. Of the six institutions without an existing program, three are currently developing or in the process of implementing fellowship programs. The increase in enrollment figures and in numbers of institutions offering programs would appear to indicate that the demand for these individuals has not yet been met.

INTRODUCTION There are increasing numbers of pharmacoeconomic and outcomes studies being conducted and published. The resultant exposure of pharmacoeconomic information provides a base from which formulary committee members, health practitioners, and public decision-makers may best determine the best use of scarce healthcare resources. While several sets of guidelines and standards have been developed to increase the consistency and validity of these assessments and reduce bias, the majority of them provide only general recommendations to the evolving discipline(1). Pharmacoeconomics has been defined as "the field of study that evaluates the behavior of individuals, firms, and markets relevant to the use of pharmaceutical products, services and programs, and which frequently focuses on the costs (inputs) and consequences (outcomes) of that use."(2) Outcomes research has been defined as "the collection and analysis of data on the use of health care products, procedures, services and programs, and the evaluation of the clinical, economic, quality of life, and patient satisfaction outcomes of that care, to determine the value of those products, procedures, services, and programs."(2)

Pharmaceutical companies have an economic incentive in demonstrating quality of life, economic, and clinical outcomes of their products and therefore have an interest in maintaining high standards for conducting pharmacoeconomic evaluations(3). Further, clinical trials are increasingly being performed in managed care settings; including both phase III trials with economic and health related quality of life components as well as phase IIIB/phase IV trials(4). One of the principal uses of pharmacoeconomics will be to influence managed care decision-making through the use of formulary and policy issues. Additionally, pharmacoeconomic and outcome studies are being used in the assessment of biotechnology drugs, therapeutic drug monitoring, and disease management(5-7). The heightened awareness of practical applications of pharmacoeconomic evaluations has led to the increased demand for the necessary experts and skilled professionals and subsequently the number of the academic programs that provide these graduates. Presently, the demand for such services exceeds the supply of qualified professionals in the area of pharmacoeconomics and the educational infrastructure may be inadequate to currently satisfy the demand(8). The number of institutions and enrollment figures for pharmacoeconomic programs housed in the nation's colleges and schools of pharmacy were last reported in 1994(9). As a follow-up to that study, a questionnaire was developed to reassess these pharmacoeconomic and outcomes research educational programs. The purpose of this paper is to present updated figures. The numbers and types of graduate and fellowship programs available, estimates of the number of individuals recently graduated from such programs, and placements of students and fellows upon completion of their programs will provide more information about the supply and demand for such graduates.

METHODS

An eleven item questionnaire was sent to one faculty member at 41 U.S. colleges and schools of pharmacy identified as having a graduate program in the social and administrative sciences by a roster maintained on the American Association of Colleges of Pharmacy web page. The first mailing was sent on February 22, 1999, with a follow-up mailing to non-respondents on April 1, 1999. Follow-up continued via telephone through June of 1999 until a 100 percent response rate was achieved. A definition of pharmacoeconomics (PE) and outcomes research (OR) per the ISPOR lexicon(2) was provided in the cover letter and on the survey instrument.

The first five items asked respondents about the existence of programs, full-time and part-time enrollment numbers, number of students completing programs in the first half of 1999, and number of students who completed the programs during the past five years. All five items asked about five categories of program type including MS, PhD, or fellowship (no degree component, with a MS component, or with a PhD component). Items six through nine asked respondents for information about placement, job title, and year of graduation for each of the five program categories for the previous five years. Item ten was concerned with sources of funding for fellowship positions and item eleven asked about any programs in development. Total enrollment numbers were completed for program type and institution. Dependent student t tests were performed to make longitudinal comparisons.

RESULTS

All of the 41 faculty contacts responded. Twenty-eight institutions indicated that they offered a MS curriculum with an emphasis in PE/OR (Table I). These programs had 135 enrollees (including 77 full-time, 35 part-time, and 23 in concert with a fellowship), 49 of whom were expected to graduate by mid-1999. This compares to 12 institutions with 28 students of whom seven were expected to graduate in July of 1994. These data represent a significant increase in both enrollment numbers and anticipated completions (P

Twenty-six institutions offer PE/OR as an emphasis area for PhD students (Table I). One hundred and sixty-five students were enrolled (including 136 full-time; six of whom had fellowships as well, and 29 part-time) in these PhD programs, 30 of whom were expected to graduate by mid-1999. This compares to 18 institutions with 57 students of whom 8 were expected to graduate in July 1994. These data also represent a significant increase in both enrollment numbers and anticipated completions (P

Three hundred and seventeen individuals were enrolled in graduate PE/OR education or fellowship programs at 35 institutions (Table II). Eighty-six people were expected to complete their studies by the end of the 1998-1999 academic year.

During the period between May 1993 and December 1998, there were a reported 98 MS degrees, 22 MS/fellowships, 2 PhD/fellowships, 104 PhD degrees, and 27 fellowships completed. Of these 254 completions, 75 (29.5 percent) secured first positions in the pharmaceutical industry and 44 (17.3 percent) went to academia. A more detailed report of placement is depicted in Table III.

All but one institution reported placements of full-time MS graduates. Of the 84 graduates available for follow-up, 38 (45 percent), went on to pursue a PhD. There were also 41 graduates of the part-time master's program at the University of Texas at Austin. Of the 106 PhDs awarded, 40 (37.7 percent) secured industry jobs and 38 (35.8 percent) accepted academic positions with the remainder distributed in variety of posts as detailed in Table III. Individuals who completed a fellowship or a fellowship with a master's degree were most apt to accept a position in the pharmaceutical industry upon program completion. Eighteen of the 22 institutions offering fellowships reported their funding sources. Twenty-four fellowships are sponsored by the pharmaceutical industry, four by government sources, three by managed care organizations, three by internal budget allocations from affiliated hospitals, and one each by a PBM, a contract research organization, and a professional association.

Of the 41 institutions surveyed, six did not have an existing program emphasizing PE/OR during the 1998-1999 academic year. However, five of the six will either initiate or develop PE/OR emphasis areas in the near future. Mercer University reported that a fellowship program in health outcomes research was to be initiated July 1, 1999. One school that has offered a fellowship program (Wisconsin) initiated a companion fellow/MS program for the 1999-2000 academic year. Rutgers University received funding for three additional fellowship positions to begin in July of 1999. Butler University is developing a fellowship and Idaho State a master's program. The University of New Mexico plans to incorporate PE/OR courses in their current graduate program curricula. The University of Florida is recruiting for an endowed chair in PE/OR to begin a focus in the area. Florida A&M University plans to implement a PhD program emphasizing PE/OR in the 2002/2003 academic year.

DISCUSSION

Investigation of the economic value of pharmaceuticals continues to experience rapid growth. The significant increase in the number of individuals enrolled in and institutions offering a MS, PhD, or fellowship and the provision of part-time master's programs for working individuals clearly illustrate this growth. This study requested information regarding curricula emphasizing PE/OR. The words pharmacoeconomics and outcomes research were defined according to the ISPOR lexicon; however it should be noted that the word emphasize was not specif ically defined and this determination was left to the discretion of the faculty member reporting the data. The breadth and depth of programs will most likely vary from institution to institution. For instance, one respondent provided two sets of enrollment numbers, one based on whether an individual had taken related course work, and another set for those considered "specializing" in PE/OR; the more conservative numbers were used in the compilation. Another program indicated that "faculty do have outcomes projects, although this is not currently an emphasis of PhD program." However, it should be noted that the individuals graduating from any of these programs may all make claim that their degree emphasized the field and may so market themselves for employment accordingly and the placement data confirm this.

While this study captures only those activities at colleges and schools of pharmacy, it should be noted that there are degree programs offered at a number of non-pharmacy institutions. The ISPOR directory of educational programs (on the ISPOR web page) lists an additional 14 such degree programs in the U.S. and 14 international programs. There are also related fellowships listed in the ACCP Directory of Residencies and Fellowships(10).

It has been reported that over 80 percent of colleges and schools of pharmacy offer some level of pharmacoeconomic education to their students and that more schools plan to offer the material in their curricula(11). This demand for new faculty members with expertise in PE/OR may account for some of the numbers seen in job placement. There may also be incentive for individuals seeking an academic appointment because of the relationship academic pharmacy has with the pharmaceutical industry. There may be increased opportunities for those individuals to secure research funding from industry. This relationship may also provide incentive for those receiving their first employment position in academia to leave the academic arena and pursue a more financially rewarding position with pharmaceutical industry. In fact one respondent reported that "at present our graduate program does not emphasize pharmacoeconomics due in part to exodus of faculty to the pharmaceutical and consulting industries from 1994-1998."

Industry has experienced increasing pressure from managed care and government sources to keep pharmacy costs in line. The response from industry has been in part to use direct to consumer advertising as well as a number of applications of the principles of PE/OR(12). Additionally it has been reported that the managed care prescription benefit has resulted in substantial growth in the pharmaceutical industry(12). A primary application of pharmacoeconomics will be to influence decision-making within managed care(4). With the obvious influence of industry, it comes as no surprise that the largest increase seen in PE/OR education has been in the provision of fellowships (seven individuals in five institutions reported in 1994 to 45 fellows in 22 institutions in 1999). Fellows are primarily employed by the pharmaceutical industry followed by academia, PBMs, contract research organizations, or managed care organizations. These placements are consistent as the vast majority of fellowships are being sponsored by the pharmaceutical industry.

It is easy to understand the motivations for so many institutions to want to "cash in" on such a hot topic. However, this may result in a decrease in other coursework, an elimination of other emphasis areas, and a decrease in other areas of research. For instance in the 1993-1994 academic year, there were a total of 138 full-time MS students and 129 full-time PhD students enrolled in social and administrative sciences (then referred to a pharmacy administration) graduate programs nationwide(13). Gregor and Draugalis reported that during this time there were 28 full-time MS (20 percent of total) and 48 fulltime PhD (37 percent of total) students specializing in PE/OR(9). These percentages have now increased to 100 of 120 MS students (83 percent of total) and 137 of 175 'students (78 percent of total) (14). It is interesting to note that the total number of MS students have decreased and the number of PhD students have increased and there has been a change in programmatic emphasis to that of PE/OR.

CONCLUSION

This paper enumerates institutions and enrollment figures for programs emphasizing PE/OR and compares them to an earlier survey. Additionally the number of individuals who graduated from these programs from May of 1993 to December of 1998 and their positions of first employment were portrayed. It has been reported that there currently exists a short supply and strong demand for professionals in the field of health care economics and that there is also a shortage of adequately trained faculty(8). Faculty positions in the area of social and administrative sciences are difficult to fill and there are not enough scientists who are trained in schools and colleges of pharmacy seeking positions in academia(15). There is a great influence by the pharmaceutical industry on the training of individuals with PE/OR skills. The increase in numbers of institutions offering programs and the plans of more institutions to begin such programs would appear to indicate that the increased demand for these individuals has not yet been met. As the social and administrative sciences graduate programs focus on PE/OR continues to grow, informed decisions must be made regarding the inevitable decreases and elimination of other disciplinary course work and emphasis areas.

References

(1) Mullins, C.D. and Ogilvie, S. "Emerging standardization in pharmacoeconomics." Clin. Ther, 20, 1194-1202(1998).

(2) Pashos, C.L., Klein, E.G, and Wanke, L.A. Ispor LexiconTM, 1st ed., International Society for Pharmacoeconomics and Outcomes Research, Princeton NJ (1998) pp. 13-14.

(3) Clemens, K., Townsend, R., Luscombe, F., Mauskopf, J., Osterhaus, J. and Bobula, J. "Methodological and conduct principles for pharmacoeconomic principles," PharmacoEconomics, 8, 169-174(1995).

(4) Luce, B. "Pharmacoeconomics and managed care: Methodologic and policy issues," Med. Decis. Making, 18(2 Supply, S4-S11(1998).

(5) Hui, J.W. and Yee, G.C. "Pharmacoeconomics of biotechnology drugs," J. Am. Pharm. Assoc., 38(1), 97-98(1998).

(6) Schumacher, G.E. and Bars J.T. "Economic and outcome issues for therapeutic drug monitoring in medicine," Ther Drug Monit., 20, 539-542(1998). (7) Chang.K. and Nash, D. "The role of pharmacoeconomic evaluations in disease management," PharmacoEconomics, 14, 11-17(1998).

(8) Copley-Merriman, K., Vanscoy, G., Angaran, D., Beis, S., Draugalis, J., Freund, D., Pellissier, J. and Schulz, R. "Panel 4: Education and skills needed to conduct, interpret, and use economic evaluations in healthcare," Value in Health, 2, 88-91(1999)

(9) Gregor, K.J. and Draugalis, J.R.. "Education and training programs in U.S. colleges of pharmacy," Am. J. Pharm. Educ., 58, 378-381(1994). (10) American College of Clinical Pharmacy. Directory of Residencies and

Fellowships - 1999. AACP, Kansas City MO (1999) pp. 156-157, 170174.

(11) Rascati, K.L., Conner, T.M. and Draugalis, J.R. "Pharmacoeconomic education in U.S. schools of pharmacy," Am. J. Pharm. Educ., 62, 167170( 1998).

(12) Murray, M.D. and Deardorff; F.W. "Does managed care fuel pharmaceutical industry growth," PharmacoEconomics, 14, 341-348(1998).

(13) AACP. Profile of Pharmacy Students. AACP, Alexandria VA (1994) pp. 80-81, 90-91.

(14) AACP. Profile of Pharmacy Students. AACP, Alexandria VA (1999) pp. 88-89, 98-99.

(15) Sorofman, B. "Graduate education in the social and administrative sciences," Am. J. Pharm. Educ., 62, 467-469(1998).

Terrence R. Jackson and JoLaine R. Draugalis

College of Pharmacy, The University ofArizona, PO. Box 210207, Tucson AZ 85721-0207

Copyright American Association of Colleges of Pharmacy Spring 2000
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