Table 1.

High-Cost Medication Review: Criteria and Rationale

Review criteria	Rationale
Clinical effectiveness	What is the strength of evidence? Results of well-constructed randomized controlled trials outweigh findings of observational case series, individual case reports, or personal anecdotal experience
Alternative therapies	Is there evidence of superiority to other less-expensive agents? If 2 medications are comparable in their likelihood to produce the same desired clinical outcome with a similar risk for side effects, then the less-expensive alternative should be selected
Safety concerns	Is inpatient administration necessary? Certain infused agents (particularly biologics) have a potential risk for significant side effects or toxicities that warrant closer observation or monitoring
Timing of treatment	Can administration of the agent be safely deferred to the outpatient setting, or does delaying treatment carry a risk for harm?
Duration of treatment	If ongoing treatment is indicated, is there a mechanism for continuing therapy after discharge? If not, then initiation in the acute care setting may not be prudent