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Croke A, Cardwell K, Clyne B, Moriarty F, McCullagh L, Smith SM. The effectiveness and cost of integrating pharmacists within general practice to optimize prescribing and health outcomes in primary care patients with polypharmacy: a systematic review. BMC PRIMARY CARE 2023; 24:41. [PMID: 36747132 PMCID: PMC9901090 DOI: 10.1186/s12875-022-01952-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 12/21/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Polypharmacy and associated potentially inappropriate prescribing (PIP) place a considerable burden on patients and represent a challenge for general practitioners (GPs). Integration of pharmacists within general practice (herein 'pharmacist integration') may improve medications management and patient outcomes. This systematic review assessed the effectiveness and costs of pharmacist integration. METHODS A systematic search of ten databases from inception to January 2021 was conducted. Studies that evaluated the effectiveness or cost of pharmacist integration were included. Eligible interventions were those that targeted medications optimization compared to usual GP care without pharmacist integration (herein 'usual care'). Primary outcomes were PIP (as measured by PIP screening tools) and number of prescribed medications. Secondary outcomes included health-related quality of life, health service utilization, clinical outcomes, and costs. Randomised controlled trials (RCTs), non-RCTs, interrupted-time-series, controlled before-after trials and health-economic studies were included. Screening and risk of bias using Cochrane EPOC criteria were conducted by two reviewers independently. A narrative synthesis and meta-analysis of outcomes where possible, were conducted; the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS In total, 23 studies (28 full text articles) met the inclusion criteria. In ten of 11 studies, pharmacist integration probably reduced PIP in comparison to usual care (moderate certainty evidence). A meta-analysis of number of medications in seven studies reported a mean difference of -0.80 [-1.17, -0.43], which indicated pharmacist integration probably reduced number of medicines (moderate certainty evidence). It was uncertain whether pharmacist integration improved health-related quality of life because the certainty of evidence was very low. Twelve health-economic studies were included; three investigated cost effectiveness. The outcome measured differed across studies limiting comparisons and making it difficult to make conclusions on cost effectiveness. CONCLUSIONS Pharmacist integration probably reduced PIP and number of medications however, there was no clear effect on other patient outcomes; and while interventions in a small number of studies appeared to be cost-effective, further robust, well-designed cluster RCTs with economic evaluations are required to determine cost-effectiveness of pharmacist integration. TRIAL REGISTRATION CRD42019139679.
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Affiliation(s)
- Aisling Croke
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Karen Cardwell
- Health Information and Quality Authority, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Laura McCullagh
- National Centre for Pharmacoeconomics, St James's Hospital, Dublin, Ireland
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - Susan M Smith
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
- Discipline of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland.
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Heupink LF, Peacocke EF, Sæterdal I, Chola L, Frønsdal K. Considerations for transferability of health technology assessments: a scoping review of tools, methods, and practices. Int J Technol Assess Health Care 2022; 38:e78. [PMID: 36321421 DOI: 10.1017/s026646232200321x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Health technology assessment (HTA) is commonly used to guide evidence-informed decisions to optimize resource use, prioritize policies, and support countries to achieve universal health coverage. Producing HTAs requires time, scientific expertise, and political commitment, but these are not available in all settings - especially in low- and middle-income countries (LMIC) where HTA processes may be less institutionalized. Transferring and adapting existing HTAs to local settings may offer a solution while reducing duplication efforts. This scoping review aims to provide an overview of tools, methods, approaches, and considerations which can aid HTA transfers. We systematically searched (from 2005 to 2020) six databases and, using predefined inclusion criteria, included twenty-two studies. Data extraction followed a structured process, while synthesis was more iterative. We identified a common approach for HTA transfers. It follows the de novo process of undertaking original HTAs, but with additional steps to assess relevance (applicability), quality, and transferability, as well as steps to adapt parameters where necessary. The EUnetHTA Adaptation Toolkit was the only tool that provided guidance for adapting multiple HTA domains. Other tools were specific to systematic reviews (n = 1) or economic evaluations (n = 12), where one provided guidance for systematic reviews of economic evaluations. Eight papers reported transferring an HTA, with only one transferring to an LMIC. Finally, we reported issues that may facilitate or hinder transferability. In conclusion, we identified fourteen transfer approaches in the form of guidance or checklists, but harmonized and pragmatic guidance for HTA transfers to suit settings with limited HTA capacity seems warranted.
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Affiliation(s)
- Lieke Fleur Heupink
- Norwegian Institute of Public Health, Global Health, Division for Health Services Oslo, Norway
| | | | - Ingvil Sæterdal
- Norwegian Institute of Public Health, Global Health, Division for Health Services Oslo, Norway
| | - Lumbwe Chola
- Norwegian Institute of Public Health, Global Health, Division for Health Services Oslo, Norway
| | - Katrine Frønsdal
- Norwegian Institute of Public Health, Global Health, Division for Health Services Oslo, Norway
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Armijo N, Espinoza M, Zamorano P, Lahoz D, Yañez T, Balmaceda C. Analisis del proceso de Evaluación de Tecnologías Sanitarias del Sistema de Protección Financiera Para Diagnósticos y Tratamientos de Alto Costo en Chile (Ley Ricarte Soto): Evaluation of the Health Technology Assessment Process of the Financial Protection System for High-Cost Diagnoses and Treatments in Chile (Ricarte Soto Law). Value Health Reg Issues 2022; 32:95-101. [PMID: 36166949 DOI: 10.1016/j.vhri.2022.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/22/2022] [Accepted: 08/09/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES In Chile, Ricarte Soto Law defines a financial protection system for high-cost health technologies through a process of prioritization and evaluation of health technologies (ETESA). This study aims to evaluate the ETESA process in terms of its technical content and its coherence with the Chilean regulatory framework. METHODOLOGY This is a documentary review of 34 reports prepared by the Ministry of Health. A data extraction matrix was applied to evaluate the elements in content and process. The analysis evaluated technical errors, process inconsistencies, and disagreements in interpreting results. RESULTS From 98 technologies, 59 were considered favorable, and 25 received coverage. A total of 20 inconsistencies were identified in the evaluation process, and 39 disagreements were documented on interpreting the results and technical errors. In the prioritization stage, we identified controversies in 44 technologies. CONCLUSION The ETESA process of the Ricarte Soto Law is generally consistent with the regulations. Nevertheless, weaknesses persist in both technical and procedural terms. It is expected that the regulatory entity can use these results to implement the necessary improvements.
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Affiliation(s)
- Nicolás Armijo
- Unidad de Evaluación de Tecnologías Sanitarias, Centro de Investigación Clínica, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Manuel Espinoza
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Paula Zamorano
- Unidad de Evaluación de Tecnologías Sanitarias, Centro de Investigación Clínica, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Daniela Lahoz
- Unidad de Evaluación de Tecnologías Sanitarias, Departamento de Investigación del Cáncer, Fundación Arturo López Pérez, Santiago, Chile
| | - Tamara Yañez
- Facultad de Química y de Farmacia, Pontificia Universidad Católica de Chile
| | - Carlos Balmaceda
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile
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Baker T, Johnson H, Kotapati S, Moshyk A, Hamilton M, Kurt M, Paly VF. Cost-Utility of Nivolumab Plus Ipilimumab in First-Line Treatment of Advanced Melanoma in the United States: An Analysis Using Long-Term Overall Survival Data from Checkmate 067. PHARMACOECONOMICS - OPEN 2022; 6:697-710. [PMID: 36006606 PMCID: PMC9440167 DOI: 10.1007/s41669-022-00348-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the cost-utility of nivolumab plus ipilimumab (NIVO + IPI) versus other first-line therapies for advanced melanoma in the United States (US) from the third-party payer perspective. METHODS This analysis estimated total expected life-years (LYs), quality-adjusted LYs (QALYs), and costs for first-line treatments of advanced melanoma during a 30-year time horizon using indirect treatment comparisons based on time-varying hazard ratios (HRs) and a three-state partitioned survival model. Overall survival (OS) and progression-free survival reference curves were extrapolated based on 5-year follow-up from the phase III Checkmate 067 trial (NCT01844505). Comparators of NIVO + IPI were NIVO, IPI, pembrolizumab, dabrafenib plus trametinib, encorafenib plus binimetinib (ENCO + BINI), and vemurafenib plus cobimetinib. Drug acquisition costs, treatment administration costs, follow-up time, subsequent therapy data, and adverse event frequencies were obtained from published sources. Utility weights were estimated from Checkmate 067, which compared NIVO + IPI or NIVO monotherapy with IPI monotherapy as first-line therapy in advanced melanoma. A 3% annual discount rate was applied to costs and outcomes. Sensitivity scenarios for BRAF-mutant subgroups were conducted. RESULTS NIVO + IPI was estimated to generate the longest OS and the highest total costs versus all comparators, accruing 6.99 LYs, 5.70 QALYs, and $469,469 over the 30-year time horizon. The incremental cost utility of NIVO + IPI versus comparators ranged from $2130 per QALY (versus ENCO + BINI) to $76,169 per QALY (versus NIVO). In all base-case and most sensitivity analyses, the incremental cost-utility ratios for NIVO + IPI were below $100,000 per QALY. CONCLUSIONS NIVO + IPI is estimated to be a life-extending and cost-effective treatment versus other therapies in the US, with base-case incremental cost-utility ratios below $100,000 per QALY.
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Affiliation(s)
- Timothy Baker
- Global Health Economics, Outcomes Research and Epidemiology, ICON plc, ICON Clinical Research, 4131 Parklake Ave., Suite 600, Raleigh, NC, 27612, USA.
| | | | | | | | | | - Murat Kurt
- Bristol Myers Squibb, Princeton, NJ, USA
| | - Victoria Federico Paly
- Global Health Economics, Outcomes Research and Epidemiology, ICON plc, ICON Clinical Research, 731Arbor Way, Suite 100, Blue Bell, PA, 19422, USA
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García-Mochón L, Rovira Forns J, Espin J. Cost transferability problems in economic evaluation as a framework for an European health care and social costs database. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:43. [PMID: 34275470 PMCID: PMC8286608 DOI: 10.1186/s12962-021-00294-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
This article presents part of the work within Work Package 3 (WP3) of Impact HTA (Improved methods and actionable tools for enhancing HTA), a H2020 EU-funded research project, intended to enhance and promote collaboration in HTA across EU MS. Amongst other objectives, and in close collaboration with WP4, WP3 addressed setting up a multi-country unit-cost database: the European health care and social costs database (EU HCSCD). The purpose of the database is to facilitate the transference of healthcare economic evaluation analyses across countries, jurisdictions and settings. WP3 concentrates on healthcare costs; WP4 on social costs. This paper discusses the state of the art on this topic, building an appropriate conceptual and theoretical framework for Database development. We conducted a broad, but not systematic, literature and gray-literature review (LR), identifying existing practices and problems, and their implications, described in the Results section. We discuss practical implications and draw important conclusions behind the construction, and future evolution, of this database.
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Affiliation(s)
- Leticia García-Mochón
- Andalusian School of Public Health, Cuesta del Observatorio 4, 18011, Granada, Spain. .,CIBER en Epidemiología y Salud Pública (CIBERESP), Spain/CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain. .,Instituto de Investigación Biosanitaria ibs, Granada, Spain.
| | - Joan Rovira Forns
- Andalusian School of Public Health, Cuesta del Observatorio 4, 18011, Granada, Spain
| | - Jaime Espin
- Andalusian School of Public Health, Cuesta del Observatorio 4, 18011, Granada, Spain.,CIBER en Epidemiología y Salud Pública (CIBERESP), Spain/CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Instituto de Investigación Biosanitaria ibs, Granada, Spain
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Gorry C, McCullagh L, Barry M. Transferability of Economic Evaluations of Treatments for Advanced Melanoma. PHARMACOECONOMICS 2020; 38:217-231. [PMID: 31761996 PMCID: PMC7081651 DOI: 10.1007/s40273-019-00860-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Differing methodological requirements and decision-making criteria are recognised as barriers to transferability of cost-effectiveness analysis (CEA) across jurisdictions. OBJECTIVE We assessed the generic and specific transferability of published CEAs of systemic treatments for advanced melanoma to the Irish setting. METHODS CEAs of treatments for melanoma were identified by systematic review. Transferability to the Irish setting was assessed using the EUnetHTA transferability tool for Economic Evaluation. We present a narrative discussion comparing the differences in key parameter inputs and the likely impact of these differences on the model outcomes and the reimbursement recommendation. Transferability is considered within the context of the Irish cost-effectiveness threshold, using the net monetary benefit (NMB) framework. RESULTS No published CEAs (n = 15) aligned with the Irish reference case for CEA. Changes to key parameters were unlikely to change the conclusions of the CEA when the cost-effectiveness threshold was considered. Ten studies (19 pairwise comparisons) were compared with findings by the National Centre for Pharmacoeconomics (NCPE) using NMB. Without accounting for differences in the cost-effectiveness threshold, there was alignment between the study conclusions and NCPE recommendations in 73.7% cases. When the Irish cost-effectiveness threshold was applied in the estimation of NMB, there was agreement in 89.5% of cases. CONCLUSIONS Alignment in methodological requirements for CEA is important to facilitate joint health technology assessment (HTA) by regional collaborations in Europe. When parameter inputs are not exactly aligned, conclusions may still be comparable across jurisdictions. For international joint procurement initiatives, determining and implementing joint decision rules may be more important than trying to align rules regarding methodological and parameter inputs.
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Affiliation(s)
- Claire Gorry
- National Centre for Pharmacoeconomics, St James Hospital, Dublin, Ireland.
| | - Laura McCullagh
- National Centre for Pharmacoeconomics, St James Hospital, Dublin, Ireland
- Department of Pharmacology and Therapeutics, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Michael Barry
- National Centre for Pharmacoeconomics, St James Hospital, Dublin, Ireland
- Department of Pharmacology and Therapeutics, School of Medicine, Trinity College Dublin, Dublin, Ireland
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