American Journal of Pharmaceutical Education 2013; 77 (3) Article 57.

RESEARCH Pharmacoeconomic Education in Egyptian Schools of Pharmacy Ahmed M. Soliman, MS, BSPharm,a Mustafa Hussein, MS, BSPharm,b and Abdulla M. Abdulhalim, BSPharmc aThe University of Minnesota College of Pharmacy, Minneapolis, Minnesota bThe University of Tennessee College of Pharmacy, Memphis, Tennessee cThe University of Maryland School of Pharmacy, Baltimore, Maryland Submitted September 5, 2012; accepted October 28, 2012; published April 12, 2013.

Objective. To investigate the status of pharmacoeconomics education in Egyptian schools of pharmacy and compile and construct recommendations on how and similar countries could improve their educational infrastructure in pharmacoeconomics. Methods. A modified version of a published survey instrument was sent to all schools of pharmacy in Egypt (n5 24). The data were assessed to identify associations between offering pharmacoeconomics education and school characteristics. Results. Usable responses were obtained from 20 schools (response rate: 83%). Only 7 schools offered pharmacoeconomics education, with a median of 20 teaching hours per semester. Among respondents, 4 schools had instructors with some training in pharmacoeconomics and only 1 school had a faculty member with PhD-level training. Only 4 schools offered graduate-level courses in pharmacoeconom- ics. Eight additional schools expressed interest in teaching pharmacoeconomics in the near future. Having 1 or more faculty members with training in pharmacoeconomics was significantly associated with offering pharmacoeconomics education (p 5 0.03). Conclusions. Pharmacoeconomics education in Egypt is still in its infancy and there exists a unique opportunity for well-trained instructors and researchers to fill this gap. Providing structured phar- macoeconomics education to student pharmacists, researchers, and stakeholders can help countries establish an integrated scientific community that can start applying pharmacoeconomic evidence to healthcare decision-making. Keywords: pharmacoeconomics, education, Egypt, curriculum by guest on September 27, 2021. © 2013 American Association of Colleges Pharmacy INTRODUCTION important in lower income countries that face more Pharmacoeconomics is “the scientific discipline that serious constraints on the allocation of their scarce evaluates the clinical, economic, and humanistic aspects healthcare resources. of pharmaceutical products, services, and programs, as Using pharmacoeconomic evidence in developing

http://www.ajpe.org well as other healthcare interventions to provide health- national formularies and essential medicines policies in care decision makers, providers, and patients with valu- developing nations can help bring a better value for the able information for optimal outcomes and allocation of investment in pharmaceuticals. Further, the use of phar- healthcare resources.”1 As such, formal pharmacoeco- macoeconomics in broader healthcare decision making in nomic evidence can potentially inform coverage and re- developing countries may help to optimize access, cost, imbursement decisions of various health interventions and quality of care for the populations of these nations.3,4 Downloaded from and technologies, as well as the development of formu- However, as Singer explains, 3 components ought to be laries and clinical practice guidelines.2 This is especially in place before the full potential of pharmacoeconomics can be realized: individuals capable of conducting the analyses; a receptive and informed audience of policy- Corresponding Author: Ahmed M. Soliman, BSPharm, MS, makers; and a body of relevant methodology and guide- Doctoral Dissertation Fellow, Social and Administrative 5 Pharmacy Graduate Program, Department of Pharmaceutical lines. Thus, it is imperative for developing countries to Care and Health Systems, College of Pharmacy, University of build an educational infrastructure of analysts and ex- Minnesota, 7-164 Weaver-Densford Hall, 308 Harvard St SE, perts in pharmacoeconomics and to promote the educa- Minneapolis, MN 55455. Tel: 612-353-7804. E-mail: tion of pharmacoeconomics at the payer, provider, and [email protected] researcher levels, each according to their needs and tasks. 1 American Journal of Pharmaceutical Education 2013; 77 (3) Article 57.

Pharmacoeconomics education has flourished in the instrument to suit our research purpose. The list of schools of developed world. The number of US pharmacy colleges pharmacy in Egypt was obtained from the Egyptian Syndi- and schools teaching pharmacoeconomics at the profes- cate of Pharmacists, which maintains a list of universities sional level increased from 80% in 1997 to 92% in 2007, that offer a pharmacy degree in the country. E-mail ad- and the colleges and schools that did not offer pharmaco- dresses and other contact information for the school deans economics courses were either new or looking for in- and department chairs were obtained from each school’s structors.6,7 Internationally, the percentage of pharmacy Web site. We presumed that the departments that may colleges and schools offering pharmacoeconomic educa- be offering pharmacoeconomics courses were clinical tion increased from 41% in 1997 to 52% in 2004.8,9 In this pharmacy, pharmacy practice, and drug technology. For international survey, usable responses were recovered every pharmacy school in Egypt, the survey instrument from only 4 Middle Eastern countries: Jordan, Lebanon, along with a cover letter explaining the purpose of the the Palestinian Territory, and Turkey. survey and providing a definition of pharmacoeconomics Egypt is a developing country classified as a lower was sent by e-mail to the department head under which middle-income country by the World Bank.10 The perfor- pharmacoeconomics was presumed to be offered, or to a mance of the health system in Egypt was ranked 63rd full-time faculty member in the same department when it among 191 countries in the 2000 World Health Report was not possible to reach the chair. To increase the re- by the World Health Organization11 using a composite sponse rate, a follow-up e-mail was sent to nonresponders measure of the overall health system performance, and 3 weeks after the first e-mail, and then the survey instru- was ranked 105th among 197 countries in 2004, based on ment was mailed to them. Finally, we attempted to contact Egypt’s disability-adjusted life expectancy.12 According to the remaining nonresponders in person with the help of the country’s national health accounts in 2007-2008, members of Egypt’s regional chapter of the International Egypt’s total health expenditure was only 4.8% of the gross Society for Pharmacoeconomics and Outcomes Research domestic product, which is 1 of the lowest among all coun- (ISPOR). The first round of survey administration was tries in the Middle East.13 Sixty percent of the country’s conducted in October 2011. In an effort to maximize the total health expenditure is paid for by households, which survey response rate, in August 2012, we conducted a sec- is the highest percentage among all middle-income coun- ond round of survey administration in which we contacted tries; 35% is financed by the Egyptian Ministry of Health.13 only schools that did not respond in the first round. Spending on pharmaceuticals makes up about 26% of total Descriptive statistics were computed for the usable healthcare expenditure in Egypt, and about a third of survey responses that were received. For a school to be households’ out-of-pocket healthcare spending.13 counted as offering pharmacoeconomics education, an Egypt has the largest number of pharmacy schools elective or required course or part of a course had to be by guest on September 27, 2021. © 2013 American Association of Colleges Pharmacy among countries in the Middle East (currently 24), and the reported that explicitly covered some of the topical areas number of pharmacists per 100,000 people is 1.7,14 mak- within pharmacoeconomics. This criterion was based on ing Egypt the major exporter of pharmacy graduates in the premise that if a school was providing its students the Middle East.15 Over 75% of all students admitted to with an educational opportunity in pharmacoeconomics, pharmacy programs in 13 Middle Eastern countries obtain then it was indeed offering pharmacoeconomics. This

http://www.ajpe.org their pharmacy education in Egypt. criterion was used in previous research on the status of We explored the current status of undergraduate pharmacoeconomics education in the United States and (professional) and graduate pharmacoeconomic educa- elsewhere.6,7,16 tion in Egyptian schools of pharmacy. To the best of our The Fisher exact test was applied to the respondents’ knowledge, this study is one of the first attempts to com- data to investigate the association between the propor- prehensively assess the extent of pharmacoeconomics ed- tion of schools offering pharmacoeconomics and certain Downloaded from ucation in a Middle Eastern country. We also sought to school characteristics, namely, type of funding source contribute to the literature on capacity building in phar- (private vs. public), whether a school was located within macoeconomic education by consolidating relevant rec- the Greater Cairo metropolitan area, and whether a school ommendations from the literature for Egypt and similar had faculty members trained in pharmacoeconomics. The countries on how to strengthen their educational infra- significance level was set at 5%. Data collection and anal- structure in pharmacoeconomics. ysis were conducted using Microsoft Excel 2007.

METHODS RESULTS The survey instrument developed by Rascati and col- As of October 2011, Egypt had 24 schools of phar- leagues7 was adapted and modified into a 15-item survey macy, with 2 campuses offering pharmacy education 2 American Journal of Pharmaceutical Education 2013; 77 (3) Article 57.

under the auspices of the Faculty of Pharmacy of Al- department. Five of the 7 schools that offered pharmaco- Azhar University. The bachelor of science in pharmacy economics had instructors with some training in pharmaco- (BS Pharm) degree remains the first professional degree economics. The pharmacy school at required to practice pharmacy in Egypt, and is awarded appears to be the only school that has a faculty member after completion of a 5-year professional program. A with formal PhD training in pharmacoeconomics. None- summary of survey results is provided in Table 1, and theless, this school reported that pharmacoeconomics is the characteristics of all pharmacy schools in Egypt are not currently offered in its curriculum. listed along with whether they offered pharmacoeconom- The main texts used in pharmacoeconomics courses ics education in Table 2. were Essentials of Pharmacoeconomics by Karen Rascati17 The survey instrument was sent to representatives at and Pharmacoeconomics by Tom Walley and co-authors.18 all 24 schools of pharmacy in Egypt, and we received The pharmacoeconomics topics most commonly taught usable responses from 20 (83% response rate). Among (Table 4) included types of health care costs and outcomes the respondents, as delineated in Table 2 and Table 3, within the economic, clinical, and humanistic outcomes only 7 (35%) schools offered pharmacoeconomics edu- model; potential applications of pharmacoeconomics in cation at the time the survey was completed. Pharmaco- various settings; assessment of health-related quality of economics was taught over a median of 20 teaching hours life; basics of decision analysis; and pharmacoepidemiol- per semester (range: 2-45 hours), which reflects that some ogy. Types of economic evaluation (eg, cost-utility anal- schools offered a dedicated course on pharmacoeconom- ysis and cost-benefit analysis) were emphasized at some ics and related topics (eg, pharmacy administration and schools as well. pharmaceutical marketing) while others offered only In addition to the 7 schools that taught pharmaco- brief coverage of pharmacoeconomics as a part of another economics either in a separate course or within other course (eg, clinical and hospital pharmacy). The median courses, 8 other schools expressed interest in offering class size at each school was 400 students (range: 150- a pharmacoeconomic course in the near future (2-4 years). 1300 students). Courses that were entirely dedicated to All the schools that responded to the question of teaching pharmacoeconomics were a required, integral how they valued the importance of pharmacoeconomics part of the curriculum. At the graduate level, only 4 schools education expressed their appreciation of the significant offered pharmacoeconomics education (Table 3). Those 4 role this field can play in optimizing healthcare decision- schools had actively enrolled master’s degree students pur- making and resource allocation. suing graduate degrees with a focus on pharmacoeconom- Among respondents, 10 schools were private and ics. Faculty responsible for teaching pharmacoeconomics 10 were located within the Greater Cairo metropolitan came from departments of pharmacology, pharmacy prac- area. There was a significant association between offering by guest on September 27, 2021. © 2013 American Association of Colleges Pharmacy tice, or drug technology (Table 3). None of the schools pharmacoeconomics and having faculty members trained had a pharmacy administration/pharmacoeconomics in pharmacoeconomics ( p 5 0.031). A school’s funding source or its location were not significantly associated with whether it offered a pharmacoeconomics course Table 1. Summary of Findings From a Survey of Egyptian ( p 5 0.35). Pharmacy Schools Regarding Incorporation of http://www.ajpe.org Pharmacoeconomics Education Within the Curriculum DISCUSSION No. (%) Pharmacoeconomic education in Egypt is still in its Schools surveyed 24 (100) infancy and only a small number of schools are teaching Respondents 20 (83) pharmacoeconomics at the undergraduate and graduate Schools offering pharmacoeconomics 7 (35) levels. Another key finding from this study was the lim- Downloaded from Schools planning to offer pharmaco-economics 15 (75) ited expertise that Egyptian schools of pharmacy have in in the next 2-4 years a this field. Formal training of instructors in pharmacoeco- Schools having faculty trained in 5 (25) nomics was limited to vocational courses except at Cairo pharmacoeconomics University. Nevertheless, 75% of responding schools ex- Schools offering pharmacoeconomics 4 (20)b pressed interest in offering pharmacoeconomics within at the graduate level a the professional curriculum, which indicates a need for Cairo University, although not offering pharmacoeconomics at the more faculty members trained in this area to teach these time of survey administration, is the only school in Egypt with a faculty with formal PhD training in pharmacoeconomics. courses. b Of the 7 schools offering pharmacoeconomics education, 4 (57%) Historically, pharmaceutical education in Egypt was also offered it at the graduate level. mostly limited to basic biomedical and pharmaceutical 3 American Journal of Pharmaceutical Education 2013; 77 (3) Article 57.

Table 2. Pharmacy Schools in Egypt: Characteristics and Status of Pharmacoeconomics Education Offering Pharmaco- Planning to Offer Average Funding Location Year Economics Pharmaco-Economics School of Pharmacy Class Sizea Sourcea (City) Establisheda Courses? in the Next 2-4 Years? Ahram Canadian University 210 Private Giza 2004 Yes Yes 600 Public Cairo 1995 Yes Yes Al-Azhar University- 700/383 Public Cairo/Assiut 1965/1993 No Yes Cairo/Assiut 1500 Public Alexandria 1955 Yes Yes 900 Public Assiut 1957 No No Beni Swef University 360 Public Beni Swef 1994 No Yes Cairo University 1500 Public Cairo 1925 No Yes Egyptian Russian University 280 Private Cairo 2006 Yes Yes Future University in Egypt 300 Private Cairo 2006 Yes Yes German University in Cairo 450 Private Cairo 2003 Yes Yes 400 Public Helwan 1994 No Yes 1200 Public Mansoura 1972 NR NR Minia University 330 Public Minia 1995 No No Misr International University 450 Private Cairo 1997 No Yes Misr University for Science 500 Private Giza 1997 No No & Technology Modern Sciences & Arts 300 Private Giza 2003 No Yes University Modern University for 200 Private Cairo 2010 NR NR Technology & Information 300 Private Beni Swef 2007 No Yes October 6th University 850 Private Cairo 1997 NR NR Pharos University 350 Private Alexandria 2006 No Yes Sinai University 300 Private Arish 2006 Yes Yes 250 Public Ismailia 1993 No No 1200 Public Tanta 1973 NR NR by guest on September 27, 2021. © 2013 American Association of Colleges Pharmacy University 1200 Public Zagazig 1976 No No a Data on funding source and year of establishment were obtained from the Web sites of each of the listed schools. Data on average class size were obtained from the responses of schools to the survey, and, for non-respondents, from the respective school’s Office of Student Affairs through a personal communication with a school’s academic/administrative official. NR: No response http://www.ajpe.org sciences, with some individual initiatives to teach and access to the financial resources and appropriate planning implement relatively newer fields of study like pharmaco- needed. economics and clinical pharmacy. We believe that the Over the last 2 decades, Egypt has seen a dramatic adoption of pharmacoeconomics in Egyptian schools of change in the funding landscape of its universities. Start- pharmacy has lagged behind for many reasons. First, the ing in the late 1990s, many privately funded schools of Downloaded from lack of awareness about the existence and importance of pharmacy have been established. All private universities pharmacoeconomics on the side of curriculum decision in Egypt are mandated to follow the same process of legal makers (deans and department chairs) poses a barrier to recognition and approval by the Ministry of Higher Edu- adopting pharmacoeconomics into the curriculum. Sec- cation and the Supreme Council of Universities as state ond, the lack of experts in this field who reside in Egypt universities do, on the basis of the Presidential Decrees makes it more difficult to recruit instructors who can teach issued for the establishment of those institutions.15,19 One this subject in the pharmacy curriculum. Third, as with interesting finding from this study is that the majority of any emerging area of education, efforts and resources schools of pharmacy offering pharmacoeconomics edu- must be expended to build sound foundations. However, cation were private schools (5 of the 7 schools, see Table 2 in most cases, the Egyptian higher education sector lacks and Table 3). We believe that this observation can be 4 American Journal of Pharmaceutical Education 2013; 77 (3) Article 57.

Table 3. Characteristics of Schools Offering Pharmacoeconomics Education in Egypt Pharmaco- Offering Pharmaco- Academic Department Faculty Trained Teaching Hours economics economics at Teaching in Pharmaco- School of Pharmacy (per semester) Class Sizea the Graduate Level? Pharmaco-economics economics?b Ahram Canadian University 45 400 No Pharmacy Practice Yes (MBA) Ain Shams University 45 600 Yes Drug Technology Yes (Courses) Egyptian Russian University 32 280 Yes Pharmacology No German University in Cairo 18 400 No Pharmacology Yes (Courses) Alexandria University 2 1300 Yes Pharmaceutics No Future University 10 175 No Pharmacy Practice No Sinai University 20 150 Yes Pharmacy Practice Yes (Diploma) Median 20 400 Average 24.6 472 a Reported numbers reflect the class size at the professional level only. b Cairo University, not listed, is the only school in Egypt with a faculty with formal PhD training in pharmacoeconomics.

attributed to the disparity in resource availability between part of the curriculum for their BSPharm and PharmD private and public universities. Typically, pharmacy degrees.26 schools that are funded through private sources have more In a wider international context, the extent of phar- opportunities to expand and teach newer fields compared macoeconomic education in Egyptian schools of phar- to public universities. macy appears to be comparable to that reported by other Although the literature search did not recover any schools outside of the United States, especially when formal studies that document the status of pharmacoeco- taking into account that the most recent report on the nomics education in a Middle Eastern country, there are international status was in 2005.8 Fifty-two percent of re- a few individually reported cases. In Saudi Arabia, several sponding schools (47 schools in 28 countries) in Nwokeji initiatives have been undertaken to develop internation- and Rascati’s international study indicated that they of- ally recognized pharmacy education and to receive inter- fered some pharmacoeconomics education (19 schools national accreditation, such as from the Canadian Council from Europe, 10 from Asia, 7 from North America [Canada for Accreditation of Pharmacy Programs (CCAPP), espe- and Mexico], and 6 from Oceania, and the rest from else- cially at schools that have taken the lead in pharmacy where).8 Nine (19%) of these schools offered pharmaco- education in that country.20 International Pharmacoeco- economics at the bachelor’s degree level only, 16 (34%) at by guest on September 27, 2021. © 2013 American Association of Colleges Pharmacy nomics courses are offered in both classroom and experi- the graduate level only, and 22 (47%) offered education ential settings during the doctor of pharmacy (PharmD) at both levels.8 In our study, 7 (35%) Egyptian schools degree at King Saud University.20 In terms of research, apparently there is an ongoing agenda in Saudi Arabia for the adoption of pharmacoeconomic analysis in for- Table 4. Topics Most Commonly Taught in Pharmacoeconomics Courses http://www.ajpe.org mulary management and healthcare decision making in their health system, especially in the National Guard and Schools Teaching, similar government-funded hospitals.21,22 Nwokeji and Topic No. % Rascati’s 2004 survey of pharmacoeconomic education Types of health care costs: Direct, 7 (100) outside of the United States documented that pharmaco- Indirect, etc economics was offered at the professional level in only 1 Applications of pharmacoeconomics 7 (100) Downloaded from school in the Middle East, in Lebanon.8 The Lebanese (Industry, Hospitals, Formulary, etc) American University, which appears to be the only school Health-related quality of life 6 (86) Decision analysis 5 (71) of pharmacy in Lebanon, lists pharmacoeconomics in 23 Epidemiology / Pharamcoepidemiology 5 (71) its pharmacy curriculum. Also, Qatar University, which Pharmaceutical Policy 4 (57) has the first school of pharmacy in Qatar that is accredited Types of pharmacoeconomic analysis 3 (43) by the CCAPP, lists pharmacoeconomics courses in the (eg CEA, CBA, CUA, CMA, BIA, 24 pharmacy curriculum and has hired faculty members Cost of Illness) who are pharmacoeconomics experts to teach and con- Abbreviations: CEA 5 Cost-Effectiveness Analysis; CBA 5 Cost- 25 duct research. The University of Jordan’s Web site in- Benefit Analysis; CUA 5 Cost-Utility Analysis; CMA 5 Cost dicates that pharmacoeconomics courses are offered as Minimization Analysis; BIA 5 Budget Impact Analysis 5 American Journal of Pharmaceutical Education 2013; 77 (3) Article 57.

offered some pharmacoeconomic education, 3 (43%) at the pharmacy or pharmacoeconomics, making it difficult to bachelor’s degree level and 4 (57%) at the bachelor’s and collect data on the particulars of graduate coursework in graduate levels (Table 1). Qualitatively, several schools pharmacoeconomics in Egypt. expressed interest in offering pharmacoeconomics courses, a few school officials requested information that would Recommendations help their institutions establish a pharmacoeconomics pro- We offer the following recommendations, consoli- gram, while others acknowledged that pharmacoeconom- dated from existing literature, on how to best proceed ics is a relatively new field that is important to the planning in building a strong foundation for pharmacoeconomics of pharmaceutical services provision in their countries.8 education in Egypt and similar low- and middle-income This study is the first attempt to report on the status of countries: pharmacoeconomics education in Egypt by conducting 1. Use well-established standardized learning out- a comprehensive survey of all 24 schools of pharmacy comes to guide course directors. Standardized- in the country using an updated survey instrument. We learning outcomes and optimal levels of also used multiple methods to maximize the response rate. education for different types of learners of phar- The response rate achieved in our study (83%) minimizes macoeconomics have been established by ISPOR the likelihood of nonresponse bias.27 taskforces.28 The review by Rascati and col- Because this is the first report on pharmacoeconomic leagues in 2004 provides an appealing summary education in Egypt, a follow-up study should be per- of those learning outcomes, with the purpose of formed in the next 2 to 3 years. Given that many schools helping teachers and learners understand their expressed their interest in teaching pharmacoeconomics educational needs and assess the ability of the in the near future, it would be useful to assess the change curricula to meet them.16 Also, the American in the extent of pharmacoeconomic education in Egypt College of Clinical Pharmacy, in collaboration over time, especially at the graduate level. Previous stud- with ISPOR, standardized the learning outcomes ies have shown that the rate of uptake of pharmacoeco- of pharmacoeconomics fellowships for phar- nomics as a part of pharmacy curriculum has generally macy residents.29 These standards can serve as increased over the last decade. Testing for a similar trend guidelines for course directors in Egypt and in Egypt should be a future goal for research in this area. other countries that plan to start offering phar- One limitation of our study is that because pharmaco- macoeconomics courses of high quality. economics may be considered a sub-discipline of both 2. Raise awareness about pharmacoeconomics pharmacy and economics, we could be missing courses among various stakeholders. This can be ac- taught in the departments of economics throughout Egypt. complished through continuing education ac- by guest on September 27, 2021. © 2013 American Association of Colleges Pharmacy By definition, however, our exploration of the status of tivities, seminars, and short courses for health pharmacoeconomics education was limited to Egyptian policy makers, physicians, pharmacists, and other schools of pharmacy. Nonetheless, anecdotal evidence professionals expected to be involved in decision- and a comprehensive Internet survey we conducted on making processes, which require a good under- the electronically published curricula (including those standing of pharmacoeconomic concepts and the

http://www.ajpe.org published in Arabic) of the schools of commerce, eco- scope of their application. nomics, and political sciences support the hypothesis that 3. Encourage formal pharmacoeconomics edu- teaching pharmacoeconomics in those departments is cation and training. Healthcare professionals highly unlikely. Further, to our knowledge, health eco- in training, such as student pharmacists and phy- nomics, the parent discipline of pharmacoeconomics, is sicians, should have formal pharmacoeconomics not traditionally an area of interest within the curricula of education as a part of their required coursework Downloaded from these schools, which are more focused on business and and experiential training. The goal would be to related subdisciplines of economics. Another potential develop their ability to apply pharmacoeconomic limitation is that we did not attempt to investigate the knowledge to critically evaluate economic evi- details of graduate-level pharmacoeconomics education dence when making decisions in their practice. in the responding schools. Our goal was primarily to doc- For other individuals interested in developing ument offering pharmacoeconomics education at any a deeper level of understanding of pharmaco- level, with a focus on the professional curriculum. Nev- economics, graduate-level training should be an- ertheless, our findings show that graduate education in other available option. Building a homegrown base pharmacoeconomics is still in its beginnings, with no for- of pharmacoeconomics experts could only be ac- mally structured programs in social and administrative complished through formal degrees (eg, doctor 6 American Journal of Pharmaceutical Education 2013; 77 (3) Article 57.

of philosophy) and research fellowships, where aspects of its health system’s capacity, available students learn how to conceptualize pharmaco- resources, societal needs and priorities, and the economics at a more advanced level, synthesize structure through which pharmacoeconomics can new clinical and economic knowledge, develop be used to inform decision making. new methodologies, and assimilate the multi- disciplinary knowledge of pharmacoeconomics CONCLUSION from its parent disciplines.16 There is a great deficit in the availability of pharmaco- These 3 pathways should be pursued in par- economics courses in pharmacy schools in Egypt at allel to maximize the overall educational benefit both the undergraduate and graduate levels. Findings in order to establish the nucleus of a pharmaco- from this study suggest that the lack of expertise in this economics scientific community in Egypt. In the subject area among faculty members is key to the deficit. initial years of development, these 3 pathways A unique opportunity exists for well-trained individuals may have to be followed by bringing foreign to fill this gap. Providing pharmacoeconomic education to experts into the country for teaching and con- pharmacy students is especially important in an era when sultation; by encouraging and funding interested evidence-based healthcare decision making may be con- students to attend international meetings, semi- sidered one of the priorities for the Egyptian government. nars, and short courses; and by offering academic scholarships for pursuing graduate education in ACKNOWLEDGMENTS countries where pharmacoeconomics is a well- The authors thank Professor C. Daniel Mullins for established discipline. reviewing and providing feedback on earlier versions of 4. Characterize and understand the structure the manuscript. The authors would also like to thank of the Egyptian health care system and its members of Egypt’s regional ISPOR chapter and Ahmed regulatory atmosphere. Although promoting El-Wakeel of the Faculty of Pharmacy at Sinai University pharmacoeconomics education appears to give for help with survey administration and data collection. a good return on investment with a great poten- No funding was obtained to complete this study. The tial to help revolutionize Egypt’s health system authors had no conflicts of interest. An earlier version of by improving its economic efficiency, improve- this study was presented as a poster at the 17th Annual ment in resource allocation by itself might not International Meeting of ISPOR in Washington, DC, in be enough to strengthen and transform health June 2012. systems. The appropriate use of credible phar- macoeconomic evidence can help strengthen REFERENCES by guest on September 27, 2021. © 2013 American Association of Colleges Pharmacy health systems only when essential structural 1. Berger ML, Bingefors K, Hedblom EC, Pashos CL, Torrance GW. and regulatory policy measures are being imple- Health Care Cost, Quality, and Outcomes: ISPOR Book of Terms. Lawrenceville, NJ: ISPOR; 2003. mented, along with continuous improvement in 2. The International Society for Pharmacoeconomics and Outcomes transparency and accountability within national Research. Pharmacoeconomics (Issues). http://www.ispor.org/ pharmacy systems.30 Healthcare-related decision- terminology/default.asp. Accessed March 30, 2012. 3. Villa LA, Skrepnek GH. Pharmacoeconomics and developing http://www.ajpe.org making in developing countries cannot blindly adopt pharmacoeconomic guidelines developed nations. Pharm Policy Law. 2012;14:17-25. 31 4. Singer ME. Developing nations special issue. Pharmacoeconomics. for health systems in industrialized countries. 2009;27(11):887-889. Some of the fundamental barriers to such a prac- 5. Singer ME. Cost-effectiveness analysis, developing nations left tice may include variation in disease burden; behind. Pharmacoeconomics. 2008;26(5):359-361. epidemiology; the potentially different values 6. Reddy M, Rascati KL, Wahawisan J, Rascati M. Downloaded from and expectations stakeholders place on health Pharmacoeconomic education in US colleges and schools of services, which directly influence their willing- pharmacy: an update. Am J Pharm Educ. 2008;72(4):Article 51. 7. Rascati KL, Conner TM, Draugalis JR. Pharmacoeconomic ness to pay and acceptability thresholds; and the education in US schools of pharmacy. Am J Pharm Educ. 1998; degree to which there is a defined regulatory 62(3):167-169. structure for the healthcare system, in terms of 8. Nwokeji ED, Rascati KL. Pharmacoeconomic education in insurance coverage, payers involved, payment colleges of pharmacy outside of the United States. Am J Pharm Educ. and reimbursement mechanisms, and pricing 2005;69(3):348-355. 3,32 9. Rascati KL, Draugalis JT, Conner T. Pharmacoeconomic practices. Specific guidelines pertinent to a education in schools of pharmacy. In: Salek S, ed. developing nation thus need to be conceptual- Pharmacoeconomics and Outcome Assessment: A Global Issue. ized and developed in the light of the different Haslemere, UK: University of Wales, Cardiff; 1999:25-32. 7 American Journal of Pharmaceutical Education 2013; 77 (3) Article 57.

10. The World Bank. How we classify countries. http://go.worldbank. 24. Qatar University College of Pharmacy. Baccalaureate of org/AJGKUS0E80. Accessed March 31, 2012. science in pharmacy degree, curricular map. http://www.qu.edu. 11. World Health Organization (WHO). World health report 2000. qa/pharmacy/program/documents/11AYFS_CPH_BSc_PD_ Geneva, Switzerland: World Health Organization (WHO); 2000. Curriculum_Map_Oct_10_2011_SK_PJ_signed.pdf. Accessed 12. World Health Organization (WHO). The global burden of April 1, 2012. disease 2004 update. Geneva, Switzerland: World Health 25. Qatar University College of Pharmacy. Faculty Bios and Organization (WHO); 2008. Research Interests, Clinical Pharmacy and Practice Section. http:// 13. Ministry of Health, Egypt, and Health Systems 20/20. National www.qu.edu.qa/pharmacy/research/faculty_bio.php. Accessed April Health Accounts 2007/2008: Egypt. Bethesda, MD: Health Systems 1, 2012. 20/20 Project, Abt Associates Inc.; 2010. 26. The University of Jordan Faculty of Pharmacy. Programs: 14. World Health Organization (WHO). World health statistics 2011. Bachelor of Science in Pharmacy. http://pharmacy.ju.edu.jo/Lists/ Geneva, Switzerland: World Health Organization; 2011. OurPrograms/Attachments/9/BSc%20Pharmacy.pdf. Accessed 15. Kheir N, Zaidan M, Younes H, Hajj ME, Wilbur K, Jewesson PJ. March 25, 2013. Pharmacy education and practice in 13 Middle Eastern countries. Am 27. Draugalis JR, Plaza CM. Best practices for survey research J Pharm Educ. 2008;72(6):Article 133. reports revisited: implications of target population, probability 16. Rascati KL, Drummond MF, Annemans L, Davey PG. Education sampling, and response rate. Am J Pharm Educ. 2009;73(8):Article in pharmacoeconomics: an international multidisciplinary view. 142. Pharmacoeconomics. 2004;22(3):139-147. 28. The International Society for Pharmacoeconomics and Outcomes 17. Rascati K. Essentials of Pharmacoeconomics. 1st ed. Research. Pharmacoeconomic & outcomes research learning Philadelphia, PA: Lippincott Williams & Wilkins; 2008. outcomes. http://www.ispor.org/education/learning_outcomes.asp. 18. Walley T, Haycox A, Boland A. Pharmacoeconomics. Accessed September 4, 2012. Edinburgh, UK: Churchill Livingstone; 2004. 29. Kane-Gill S, Reddy P, Gupta SR, Bakst AW. Guidelines for 19. Minister’s of Higher Education Bureau. A Guide on faculties and pharmacoeconomic and outcomes research fellowship training institutes of higher education in the arab republic of egypt (p. 436– programs: joint guidelines from the American College of Clinical 589). http://www.egy-mhe.gov.eg/english/guide2008.pdf. Accessed Pharmacy and the International Society of Pharmacoeconomics October 1, 2012. and Outcomes Research. Pharmacotherapy. 2008;28(12):1552- 20. Asiri YA. Emerging frontiers of pharmacy education in Saudi 1552. Arabia: the metamorphosis in the last fifty years. Saudi Pharm J. 30. Babar ZU, Scahill SL. Is there a role for pharmacoeconomics in 2011;19(1):1-8. developing countries? Author’s reply. Pharmacoeconomics. 2011; 21. Alsultan MS. The role of pharmacoeconomics in formulary 29(5):436-437. decision making in different hospitals in Riyadh, Saudi Arabia. Saudi 31. Oortwijn W, Mathijssen J, Banta D. The role of health Pharm J. 2011;19(1):51-56. technology assessment on pharmaceutical reimbursement in 22. Al-Jazairi AS, Al-Qadheeb NS, Ajlan A. Pharmacoeconomic selected middle-income countries. Health Policy. 2010;95(2-3): analysis in Saudi Arabia: an overdue agenda item for action. Ann 174-184. Saudi Med. 2011;31(4):335-341. 32. Shillcutt SD Walker DG, Goodman CA, Mills AJ. Cost 23. Lebanese American University School of Pharmacy. Full effectiveness in low- and middle-income countries: a review of

by guest on September 27, 2021. © 2013 American Association of Colleges Pharmacy pharmacy curriculum. http://pharmacy.lau.edu.lb/programs/ the debates surrounding decision rules. Pharmacoeconomics. curriculum/ataglance.php. Accessed April 1, 2012. 2009;27(11):903-917. http://www.ajpe.org Downloaded from

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