1
|
Amir M, Zehra A, Munawar R, Gul W, Fatima T, Khan Y, Jaffery R, Babar ZUD. Economic evaluation of clinical pharmacy service using integrated health system in tertiary care hospital. Expert Rev Pharmacoecon Outcomes Res 2024; 24:533-539. [PMID: 38362677 DOI: 10.1080/14737167.2024.2319593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Clinical pharmacy services are the specialized practices of pharmacists to provide pharmaceutical care. All these activities are documented as pharmacist interventions to avoid medication errors which occur during prescribing, dispensing, and administration. The purpose of this study is to conduct an economic analysis of the pharmacist interventions using integrated health system. RESEARCH DESIGN AND METHODS A retrospective study was conducted in a tertiary care hospital. Pharmacist interventions were analyzed by an independent pharmacist. Cost-saving and cost avoidance analyses were carried out for drug-related interventions. Economic analysis was performed and tabulated both in PKR and USD. RESULTS Out of 1330 interventions, 1250 (95%) interventions were accepted and changed the prescription upon the physician-pharmacist consultation while 71 (5%) were not accepted. Interventions related to prescribing and duplication errors were the highest of all (30 and 29% respectively). Pharmacist interventions were recorded with a 95% acceptance rate. Cost analysis showed that pharmacist interventions saved around 105,115.88 US dollars. CONCLUSION Clinical pharmacy services provided by integrated health system are a cost saving program. The cost saved per intervention for our study is around USD 37 which is more than another similar study which quoted USD 30.35 per intervention.
Collapse
Affiliation(s)
- Muhammad Amir
- Department of Pharmacy Services, Lady Reading Hospital-MTI, Peshawar, Pakistan
| | - Ale Zehra
- Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Rabya Munawar
- Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Wajiha Gul
- Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Tehreem Fatima
- Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Younas Khan
- Department of Pharmacy Services, Lady Reading Hospital-MTI, Peshawar, Pakistan
| | - Razia Jaffery
- Department of Pharmacy Practice, Salim Habib University, Karachi, Pakistan
| | | |
Collapse
|
2
|
Crosby A, Jennings JK, Mills AT, Silcock J, Bourne RS. Economic evaluations of adult critical care pharmacy services: a scoping review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:574-584. [PMID: 37607337 DOI: 10.1093/ijpp/riad049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 07/05/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES To summarise the extent and type of evidence available regarding economic evaluations of adult critical care pharmacy services in the context of UK practice. METHODS A literature search was conducted in eight electronic databases and hand searching of full-text reference lists. Of 2409 journal articles initially identified, 38 were included in the final review. Independent literature review was undertaken by two investigators in a two-step process against the inclusion and exclusion criteria; title and abstract screening were followed by full-text screening. Included studies were taken from high-income economy countries that contained economic data evaluating any key aspect of adult critical care pharmacy services. Grey literature and studies that could not be translated into the English language were excluded. RESULTS The majority were before-and-after studies (18, 47%) or other observational studies (17, 45%), and conducted in North America (25, 66%). None of the included studies were undertaken in the UK. Seven studies (18%) included cost-benefit analysis; all demonstrated positive cost-benefit values for clinical pharmacist activities. CONCLUSIONS Further high-quality primary research focussing on the economic evaluation of UK adult critical care pharmacy services is needed, before undertaking a future systematic review. There is an indication of a cost-benefit value for critical care pharmacist activities. The lack of UK-based economic evaluations is a limitation to further development and standardisation of critical care pharmacy services nationally.
Collapse
Affiliation(s)
- Alex Crosby
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jennifer K Jennings
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Anna T Mills
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jonathan Silcock
- Faculty of Life Sciences, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Richard S Bourne
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK
| |
Collapse
|
3
|
Phimarn W, Saramunee K, Leelathanalerk A, Srimongkon P, Chanasopon S, Phumart P, Paktipat P, Babar ZUD. Economic evaluation of pharmacy services: a systematic review of the literature (2016-2020). Int J Clin Pharm 2023; 45:1326-1348. [PMID: 37233864 DOI: 10.1007/s11096-023-01590-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/01/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Economic evaluation is crucial for healthcare decision-makers to select effective interventions. An updated systematic review of the economic evaluation of pharmacy services is required in the current healthcare environment. AIM To conduct a systematic review of literature on economic evaluation of pharmacy services. METHOD Literature (2016-2020) was searched on PubMed, Web of Sciences, Scopus, ScienceDirect, and SpringerLink. An additional search was conducted in five health economic-related journals. The studies performed an economic analysis describing pharmacy services and settings. The reviewing checklist for economic evaluation was used for quality assessment. The incremental cost-effectiveness ratio and willingness-to-pay threshold were the main measures for cost-effective analysis (CEA) and cost-utility analysis (CUA), while cost-saving, cost-benefit-ratio (CBR), and net benefit were used for cost-minimization analysis (CMA) and cost-benefit analysis (CBA). RESULTS Forty-three articles were reviewed. The major practice settings were in the USA (n = 6), the UK (n = 6), Canada (n = 6), and the Netherlands (n = 6). Twelve studies had good quality according to the reviewing checklist. CUA was used most frequently (n = 15), followed by CBA (n = 12). Some inconsistent findings (n = 14) existed among the included studies. Most agreed (n = 29) that pharmacy services economically impact the healthcare system: hospital-based (n = 13), community pharmacy (n = 13), and primary care (n = 3). Pharmacy services were found to be cost-effectiveness or cost-saving among both developed (n = 32) and in developing countries (n = 11). CONCLUSION The increased use of economic evaluation of pharmacy services confirms the worth of pharmacy services in improving patients' health outcomes in all settings. Therefore, economic evaluation should be incorporated into developing innovative pharmacy services.
Collapse
Affiliation(s)
- Wiraphol Phimarn
- Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
| | - Kritsanee Saramunee
- Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand.
| | - Areerut Leelathanalerk
- Health Services and Pharmacy Practice Research and Innovation Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
- Clinical Trials and Evidence-Based Syntheses Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
| | - Pornchanok Srimongkon
- Health Services and Pharmacy Practice Research and Innovation Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
- Clinical Trials and Evidence-Based Syntheses Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
| | - Suratchada Chanasopon
- Health Services and Pharmacy Practice Research and Innovation Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
- Clinical Trials and Evidence-Based Syntheses Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
| | - Panumart Phumart
- Health Services and Pharmacy Practice Research and Innovation Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
- Clinical Trials and Evidence-Based Syntheses Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
| | - Pawich Paktipat
- Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
- Health Services and Pharmacy Practice Research and Innovation Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
- Clinical Trials and Evidence-Based Syntheses Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, 44150, Thailand
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| |
Collapse
|
4
|
Kvarnström K, Niittynen I, Kallio S, Lindén-Lahti C, Airaksinen M, Schepel L. Developing an In-House Comprehensive Medication Review Training Program for Clinical Pharmacists in a Finnish Hospital Pharmacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6158. [PMID: 37372745 DOI: 10.3390/ijerph20126158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/31/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
Long-term continuing education programs have been a key factor in shifting toward more patient-centered clinical pharmacy services. This narrative review aims to describe the development of Helsinki University Hospital (HUS) Pharmacy's in-house Comprehensive Medication Review Training Program (CMRTP) and how it has impacted clinical pharmacy services in HUS. The CMRTP was developed during the years 2017-2020. The program focuses on developing the special skills and competencies needed in comprehensive medication reviews (CMRs), including interprofessional collaboration and pharmacotherapeutic knowledge. The program consists of two modules: (I) Pharmacist-Led Medication Reconciliation, and (II) CMR. The CMRTP includes teaching sessions, self-learning assignments, medication reconciliations, medication review cases, CMRs, a written final report, and a self-assessment of competence development. The one-year-long program is coordinated by a clinical teacher. The program is continuously developed based on the latest guidelines in evidence-based medicine and international benchmarking in cooperation with the University of Helsinki. With the CMRTP, we have adopted a more patient-centered role for our clinical pharmacists and remarkably expanded the services. This program may be benchmarked in other countries where the local education system does not cover clinical pharmacy competence well enough and in hospitals where the clinical pharmacy services are not yet very patient-oriented.
Collapse
Affiliation(s)
- Kirsi Kvarnström
- HUS Pharmacy, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland
- HUS Internal Medicine and Rehabilitation, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland
| | - Ilona Niittynen
- HUS Pharmacy, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland
| | - Sonja Kallio
- The Association of Finnish Pharmacies, 00510 Helsinki, Finland
| | - Carita Lindén-Lahti
- HUS Pharmacy, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland
| | - Lotta Schepel
- HUS Pharmacy, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland
- Quality and Patient Safety, Shared Group Services, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland
| |
Collapse
|
5
|
Urick BY, Peters A, Pathak S, Vest MH, Colmenares E, Blanchard C, Easter J, Foushee L, DeFalco P. Telehealth medication management and health care spending in a Medicare Accountable Care Organization. J Manag Care Spec Pharm 2023; 29:357-364. [PMID: 36989448 PMCID: PMC10387942 DOI: 10.18553/jmcp.2023.29.4.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND: Value-based care is an opportunity for medication optimization services to improve medication management and reduce health care spending. The reach of these services may be extended through telehealth. However, as health care systems and payers grapple with the long-term financing of telehealth, real-world assessments are needed to evaluate the potential economic impact of pharmacy-driven telehealth services. OBJECTIVE: To evaluate the impact of a scalable pharmacist-driven telehealth intervention to improve medication management on health care spending for clinically complex patients who were enrolled in a Medicare Next Generation Accountable Care Organization. METHODS: Data for this pretest-posttest nonequivalent group design study came from Medicare claims from 2015 to 2020 and linked pharmacist care activity data derived from the electronic medical record. Patients in the intervention group were identified as those who received the telehealth medication management service. Patients in the control group were offered the service and refused or could not be contacted. The primary outcome was total medical spending over a 6-month period, and impact was assessed using a covariate-adjusted difference-in-difference model. RESULTS: There were 581 patients who received the intervention and 1,765 who served as controls. The telehealth intervention reduced total medical spending by $2,331.85 per patient over the first 6 months of the service ($388.50 per month; P = 0.0261). Across a range of estimates for the cost of service delivery, we find a return on investment of 3.6:1 to 5.2:1. CONCLUSIONS: The $388.50 monthly savings found in this study represent a substantial reduction in health care spending and emphasize the opportunity for telehealth delivery of medication management services to improve value as a part of alternative payment models. DISCLOSURES: This study was funded by the UNC Health Care Department of Pharmacy. Dr Urick has received personal fees from Pharmacy Quality Solutions and Cardinal Health. Drs Peters, Vest, Colmenares, Foushee, and DeFalco are employees of UNC Health Care Department of Pharmacy. Mr Easter received a Co-PI grant from NACDS Foundation to implement Community-based Value Care Initiative (CVCI) in a community pharmacy setting. He also received a grant to Eshelman School of Pharmacy. He has an individual consulting agreement with digital health company Truentity Health to provide go to market strategy for medication management services. He also has stock options from Truentity Health as a component of the consulting agreement. Dr Foushee has a leadership or fiduciary role at Member-At-Large and the Ambulatory Care Academy of the North Carolina Association of Pharmacists. At the time this work was conducted, Dr Urick, Dr Pathak, and Dr Blanchard were all employees of the UNC Eshelman School of Pharmacy.
Collapse
Affiliation(s)
- Benjamin Y Urick
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
- Prime Therapeutics, Eagan, MN
| | - Amanda Peters
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
- UNC Health Department of Pharmacy, Chapel Hill
| | - Shweta Pathak
- Sheps Center for Health Services Research, Chapel Hill, NC
| | - Mary-Haston Vest
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
- UNC Health Department of Pharmacy, Chapel Hill
| | - Evan Colmenares
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
- UNC Health Department of Pharmacy, Chapel Hill
| | | | - Jon Easter
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
| | | | | |
Collapse
|
6
|
O'Connell J, Grau L, Manson SM, Bott AM, Sheffer K, Steers R, Jiang L. Use of clinical pharmacy services by American Indians and Alaska Native adults with cardiovascular disease. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022; 5:800-811. [PMID: 36246030 PMCID: PMC9544095 DOI: 10.1002/jac5.1651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022]
Abstract
Introduction The Indian Health Service (IHS) and Tribal health programs provide clinical pharmacy services to improve health outcomes among American Indian and Alaska Native (AI/AN) adults with cardiovascular disease (CVD). Objectives The study's primary objective was to describe characteristics, including social determinants of health (SDOH), associated with clinical pharmacy utilization by AI/ANs with CVD who accessed IHS/Tribal services. A secondary objective assessed changes in systolic blood pressure (SBP) associated with such utilization. Methods Analysis included IHS data for 9844 adults aged 18 and older with CVD who lived in 5 locations. Multivariable logistic regression was used to examine patient characteristics (eg, age, sex, health status, SDOH) associated with clinical pharmacy utilization in fiscal year (FY) 2012. A propensity score model was employed to estimate the association of elevated SBP in FY2013 with FY2012 clinical pharmacy utilization. Results Nearly 15% of adults with CVD used clinical pharmacy services. Among adults with CVD, the odds of clinical pharmacy use were higher among adults diagnosed with congestive heart failure (adjusted odds ratio [OR] = 1.22; 95% CI:1.01-1.47), other types of heart disease not including ischemia (OR = 1.40; 95% CI: 1.18-1.65), and vascular disease (OR = 1.23; 95% CI: 1.04-1.46), compared to adults without these conditions. Diabetes (OR = 4.05, 95% CI: 3.29-5.00) and anticoagulation medication use (OR = 20.88, 95% CI: 16.76-20.61) were associated with substantially higher odds of clinical pharmacy utilization. Medicaid coverage (OR = 0.72; 95% CI: 0.56-0.93) and longer travel times to services (OR = 0.87; 95% CI: 0.83-0.92) were each associated with lower odds. FY2012 clinical pharmacy users had lower odds of elevated SBP (OR = 0.71 95% CI: 0.58-0.87) in FY2013 than nonusers. Conclusion In addition to health status, SDOH (eg, Medicaid coverage, longer travel times) influenced clinical pharmacy utilization. Understanding characteristics associated with clinical pharmacy utilization may assist IHS/Tribal health programs in efforts to support optimization of these services.
Collapse
Affiliation(s)
- Joan O'Connell
- Present address:
Centers for American Indian and Alaska Native Health, Colorado School of Public HealthUniversity of ColoradoAuroraColoradoUSA
| | - Laura Grau
- Present address:
Department of Biostatistics, Colorado School of Public HealthUniversity of ColoradoAuroraColoradoUSA
| | - Spero M. Manson
- Present address:
Centers for American Indian and Alaska Native Health, Colorado School of Public HealthUniversity of ColoradoAuroraColoradoUSA
| | | | - Kyle Sheffer
- Santa Fe Indian Health CenterSanta FeNew MexicoUSA
| | | | - Luohua Jiang
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaIrvineCaliforniaUSA
| |
Collapse
|
7
|
White CM. Pharmacists Have the Stats but No Provider Status: Now May Be Our Moment. Ann Pharmacother 2022; 56:1181-1183. [PMID: 35107031 DOI: 10.1177/10600280211036160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- C Michael White
- University of Connecticut School of Pharmacy, Storrs, CT, USA
| |
Collapse
|
8
|
Nesbit SA, Haas CE, Carter BL, Kehoe WA, Jacobi J, D'Amico HR, Peace JT. Development of clinical pharmacy quality measures: A call to action. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Judi Jacobi
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | |
Collapse
|
9
|
Jay JS, Ijioma SC, Holdford DA, Dixon DL, Sisson EM, Patterson JA. The cost-effectiveness of pharmacist-physician collaborative care models vs usual care on time in target systolic blood pressure range in patients with hypertension: a payer perspective. J Manag Care Spec Pharm 2021; 27:1680-1690. [PMID: 34818090 PMCID: PMC10390951 DOI: 10.18553/jmcp.2021.27.12.1680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Hypertension is highly prevalent in the United States, affecting nearly half of all adults (43%). Studies have shown that pharmacist-physician collaborative care models (PPCCMs) for hypertension management significantly improve blood pressure (BP) control rates and provide consistent control of BP. Time in target range (TTR) for systolic BP is a novel measure of BP control consistency that is independently associated with decreased cardiovascular risk. There is no evidence that observed improvement in TTR for systolic BP with a PPCCM is cost-effective. OBJECTIVE: To compare the cost-effectiveness of a PPCCM with usual care for the management of hypertension from the payer perspective. METHODS: We used a decision analytic model with a 3-year time horizon based on published literature and publicly available data. The population consisted of adult patients who had a previous diagnosis of high BP (defined as office-based BP ≥ 140/90 mmHg) or were receiving antihypertensive medications. Effectiveness data were drawn from 2 published studies evaluating the effect of PPCCMs (vs usual care) on TTR for systolic BP and the impact of TTR for systolic BP on 4 cardiovascular outcomes (nonfatal myocardial infarction [MI], stroke, heart failure [HF], and cardiovascular disease [CVD] death). The model incorporated direct medical costs, including both programmatic costs (ie, direct costs for provider time) and downstream health care utilization associated with acute cardiovascular events. One-way sensitivity and threshold analyses examined model robustness. RESULTS: In base-case analyses, PPCCM hypertension management was associated with lower downstream medical expenditures (difference: -$162.86) and lower total program costs (difference: -$108.00) when compared with usual care. PPCCM was associated with lower downstream medical expenditures across all parameter ranges tested in the deterministic sensitivity analysis. For every 10,000 hypertension patients managed with PPCCM vs usual care over a 3-year time horizon, approximately 27 CVD deaths, 29 strokes, 21 nonfatal MIs, and 12 incident HF diagnoses are expected to be averted. CONCLUSIONS: This is the first study to evaluate the cost-effectiveness of PPCCM compared to usual care on TTR for systolic BP in adults with hypertension. PPCCM was less costly to administer and resulted in downstream health care savings and fewer acute cardiovascular events relative to usual care. Although further research is needed to evaluate the long-term costs and outcomes of PPCCM, payer coverage of PPCCM services may prevent future health care costs and improve patient cardiovascular outcomes. DISCLOSURES: No funding was received for the completion of this research. The authors have nothing to disclose. Study results were presented as an abstract at the AMCP 2021 Virtual, April 12-16, 2021.
Collapse
Affiliation(s)
- Jessica S Jay
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
| | - Stephen C Ijioma
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
| | - David A Holdford
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
| | - Dave L Dixon
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
| | - Evan M Sisson
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
| | - Julie A Patterson
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
| |
Collapse
|
10
|
Carr‐Lopez SM, Strohecker LA, Miyahara RK, Patel RA, Mai YT, Shek A, Law EJ. Impact of a veterans affairs primary care collaboration to provide remote
team‐based
care and telehealth introductory pharmacy practice experiences. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Sian M. Carr‐Lopez
- Primary Care Service VA Northern California Health Care System Mather California USA
- Department of Pharmacy Practice University of the Pacific Thomas J. Long School of Pharmacy Stockton California USA
| | - Lorrie A. Strohecker
- Primary Care Service VA Northern California Health Care System Mather California USA
| | - Randell K. Miyahara
- Primary Care Service VA Northern California Health Care System Mather California USA
- Department of Pharmacy Practice University of the Pacific Thomas J. Long School of Pharmacy Stockton California USA
| | - Rajul A. Patel
- Primary Care Service VA Northern California Health Care System Mather California USA
- Department of Pharmacy Practice University of the Pacific Thomas J. Long School of Pharmacy Stockton California USA
| | - Yvonne T. Mai
- Primary Care Service VA Northern California Health Care System Mather California USA
- Department of Pharmacy Practice University of the Pacific Thomas J. Long School of Pharmacy Stockton California USA
| | - Allen Shek
- Primary Care Service VA Northern California Health Care System Mather California USA
- Department of Pharmacy Practice University of the Pacific Thomas J. Long School of Pharmacy Stockton California USA
| | - Elaine J. Law
- Primary Care Service VA Northern California Health Care System Mather California USA
- Department of Pharmacy Practice University of the Pacific Thomas J. Long School of Pharmacy Stockton California USA
| |
Collapse
|
11
|
Patanwala AE, Narayan SW, Haas CE, Abraham I, Sanders A, Erstad BL. Proposed guidance on cost-avoidance studies in pharmacy practice. Am J Health Syst Pharm 2021; 78:1559-1567. [PMID: 34007979 DOI: 10.1093/ajhp/zxab211] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Cost-avoidance studies of pharmacist interventions are common and often the first type of study conducted by investigators to quantify the economic impact of clinical pharmacy services. The purpose of this primer is to provide guidance for conducting cost-avoidance studies pertaining to clinical pharmacy practice. SUMMARY Cost-avoidance studies represent a paradigm conceptually different from traditional pharmacoeconomic analysis. A cost-avoidance study reports on cost savings from a given intervention, where the savings is estimated based on a counterfactual scenario. Investigators need to determine what specifically would have happened to the patient if the intervention did not occur. This assessment can be fundamentally flawed, depending on underlying assumptions regarding the pharmacists' action and the patient trajectory. It requires careful identification of the potential consequence of nonaction, as well as probability and cost assessment. Given the uncertainty of assumptions, sensitivity analyses should be performed. A step-by-step methodology, formula for calculations, and best practice guidance is provided. CONCLUSIONS Cost-avoidance studies focused on pharmacist interventions should be considered low-level evidence. These studies are acceptable to provide pilot data for the planning of future clinical trials. The guidance provided in this article should be followed to improve the quality and validity of such investigations.
Collapse
Affiliation(s)
- Asad E Patanwala
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Australia, and Royal Prince Alfred Hospital, Sydney, Australia
| | - Sujita W Narayan
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Australia
| | - Curtis E Haas
- University of Rochester Medical Center, Rochester, NY, USA
| | - Ivo Abraham
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Arthur Sanders
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Brian L Erstad
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
| |
Collapse
|
12
|
Narayan SW, Abraham I, Erstad BL, Haas CE, Sanders A, Patanwala AE. Methods used to attribute costs avoided from pharmacist interventions in acute care: A scoping review. Am J Health Syst Pharm 2021; 78:1576-1590. [PMID: 34003209 DOI: 10.1093/ajhp/zxab214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Cost-avoidance studies are common in pharmacy practice literature. This scoping review summarizes, critiques, and identifies current limitations of the methods that have been used to determine cost avoidance associated with pharmacists' interventions in acute care settings. METHODS An Embase and MEDLINE search was conducted to identify studies that estimated cost avoidance from pharmacist interventions in acute care settings. We included studies with human participants and articles published in English from July 2010 to January 2021, with the intent of summarizing the evidence most relevant to contemporary practice. RESULTS The database search retrieved 129 articles, of which 39 were included. Among these publications, less than half (18 of 39) mentioned whether the researchers assigned a probability for the occurrence of a harmful consequence in the absence of an intervention; thus, a 100% probability of a harmful consequence was assumed. Eleven of the 39 articles identified the specific harm that would occur in the absence of intervention. No clear methods of estimating cost avoidance could be identified for 7 studies. Among all 39 included articles, only 1 attributed both a probability to the potential harm and identified the cost specific to that harm. CONCLUSION Cost-avoidance studies of pharmacists' interventions in acute care settings over the last decade have common flaws and provide estimates that are likely to be inflated. There is a need for guidance on consistent methodology for such investigations for reporting of results and to confirm the validity of their economic implications.
Collapse
Affiliation(s)
- Sujita W Narayan
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Australia
| | - Ivo Abraham
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Brian L Erstad
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Curtis E Haas
- University of Rochester Medical Center, Rochester, NY, USA
| | - Arthur Sanders
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Asad E Patanwala
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Australia, and Royal Prince Alfred Hospital, Sydney, Australia
| |
Collapse
|
13
|
Rascati KL. Economic evaluations of clinical pharmacy services: What's next? JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Karen L. Rascati
- College of Pharmacy The University of Texas at Austin Austin Texas
| |
Collapse
|