Economic evaluation of pharmacy services: a systematic review of the literature (2016-2020)

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.

Factors associated with pharmacotherapy course learning achievements in Thai pharmacy students

INTRODUCTION

The doctor of pharmacy (PharmD) program is designed for direct patient care experiences. To prepare pharmacy students to have adequate clinical knowledge and skills, pharmacotherapy is a vital course. Due to the difficulties of courses, several students had unsuccessful learning achievements and insufficient clinical skills. The objective was to explore factors associated with pharmacotherapy course learning achievements in pharmacy students.

METHODS

A cross sectional survey was designed and undertaken in 2020. Pharmacy students who enrolled at least one pharmacotherapy course were included. A 39-item questionnaire was developed and distributed electronically. Content validity and reliability tests (Cronbach's α = 0.928) were performed. Descriptive statistics and univariate and logistic regression were used in this study.

RESULTS

The results indicated that four factors were found to be associated with higher grade point average: participation in a study group (adjusted odds ratio [OR] 0.47, 95% CI 0.23-0.97) for Pharmacotherapy I; self-assessed success for Pharmacotherapy II and Advanced Pharmacotherapy (adjusted OR 2.67, 95% CI 1.19-6.01 and adjusted OR 3.45, 95% CI 1.03-11.59, respectively); using social media in the classroom (adjusted OR 12.16, 95% CI 2.03-72.72); and motivation by advisors (adjusted OR 640.74, 95% CI 2.03-201,675.55) for Pharmacotherapy III. Moreover, reviewing material after class (adjusted OR 0.27, 95% CI 0.10-0.71) and using social media in the classroom (adjusted OR 2.03, 95% CI 1.01-4.07) revealed the association with cumulative grade point average.

CONCLUSIONS

There were various factors associated with pharmacotherapy learning achievements. These included factors from learners, instructors, and environment.

Efficacy of Varenicline in the Treatment of Alcohol Dependence: An Updated Meta-Analysis and Meta-Regression

BACKGROUND

Although varenicline has been used for alcohol dependence (AD) treatment, its efficacy for this condition remains controversial.

AIMS

This systematic review and meta-analysis of randomized controlled trials (RCTs) assesses the efficacy and safety of varenicline in patients with AD.

METHODS

PubMed, Cochrane Library, ScienceDirect, Web of Science, and ThaiLis were systematically searched. RCTs investigating the efficacy and safety of varenicline in patients with AD were included. Study selection, data extraction, and quality assessment were independently performed by two authors. The Jadad score and Cochrane risk of bias were used to assess the quality of the included studies. Heterogeneity was assessed using I² and chi-squared tests.

RESULTS

Twenty-two high-quality RCTs on 1421 participants were included. Varenicline significantly reduced alcohol-related outcomes compared with placebo based on percentage of abstinent days (standardized mean difference [SMD] 4.20 days; 95% confidence interval [CI]: 0.21, 8.19; p = 0.04), drinks per day (SMD -0.23 drinks; 95% CI: -0.43, -0.04; p = 0.02), drinks per drinking day (SMD -0.24 drinks; 95% CI: -0.44, -0.05; p = 0.01), craving assessed using the Penn alcohol craving scale (SMD -0.35; 95% CI: -0.59, -0.12; p = 0.003), and craving assessed using the alcohol urge questionnaire (SMD -1.41; 95% CI: -2.12, -0.71; p < 0.0001). However, there were no significant effects on abstinence rate, percentage of drinking days, percentage of heavy drinking days, alcohol intoxication, or drug compliance. Serious side effects were not observed in the varenicline or placebo groups.

CONCLUSION

Our results indicated that AD patients treated with varenicline showed improvement in percentage of very heavy drinking days, percentage of abstinent days, drinks per day, drinks per drinking day, and craving. However, well-designed RCTs with a large sample size and long duration on varenicline treatment in AD remain warranted to confirm our findings.

A meta-analysis and meta-regression study of the effects of Triphala on anthropometric parameters

Triphala is a medicinal plant that can improve anthropometric parameters. Although Triphala is widely used, especially in India and Thailand, its efficacy is still controversial. Consequently, the purpose of this meta-analysis and meta-regression analysis was to assess the safety of Triphala and its effects on anthropometric parameters. A comprehensive review and meta-analysis of randomized controlled trials assessing the safety of Triphala and its effects on anthropometric parameters were conducted by searching PubMed, ScienceDirect, Web of Science, and ThaiLIS databases. Two authors independently conducted the study selection and data extraction and evaluated the quality of the studies. The clinical therapeutic effects and adverse events of Triphala were evaluated and aggregated using a random-effects model. The chi-square and I2 tests were used to assess heterogeneity between the studies. Seven trials with a total of 458 patients were included. The Triphala-treated groups demonstrated a considerable decrease in body weight (BW) (weighted mean difference [WMD]: −2.99 kg; 95% CI: −5.31, −0.67; P = 0.012; I2 = 94.4%), body mass index (BMI) (WMD: −0.79 kg/m2; 95% CI: −1.52, −0.07; P = 0.032; I2 = 90.4%), and waist circumference (WC) (WMD: −1.86 cm; 95% CI: −3.10, −0.62; P = 0.003; I2 = 88.8%). During the treatment period, there were no reports of serious adverse events related to Triphala. However, there was no association between the dose or duration of treatment and any of the recorded outcomes. This meta-analysis revealed that Triphala significantly improved BW, BMI, and WC. Nevertheless, substantial, well-designed randomized controlled studies are necessary to confirm this finding.

Efficacy of Vernonia cinerea (L) Less for smoking cessation: An updated meta-analysis of randomized controlled trials

Vernonia cinerea (VC) has been used for smoking cessation. A previous meta-analysis (MA) reported the efficacy of VC in smoking cessation. However, there have been updated randomized controlled trials (RCTs) on the efficacy of VC for smoking cessation, and the previous MA lacked pooled adverse events (AEs) related to VC. The objective of this study was to systematically review and perform an updated MA on the efficacy of VC for smoking cessation continuous abstinence rate (CAR), prevalence abstinence (PAR), and AE. The research articles were retrieved via electronic databases including PubMed, Science Direct, Web of Science, Thai-Journal Citation Index Center (TCI), and ThaiLis. Ten RCTs published prior to 2019 were included in this study. The number of participants in the studies ranged from 35 to 172, and the follow-up duration for the primary outcomes was 2-12 weeks. Our updated MA found that VC could significantly improve CAR2 (RR=1.54; 95% CI = 1.06, 2.23), CAR4 (RR=1.65; 95% CI = 1.25, 2.17), CAR 8 (RR=1.85; 95% CI = 1.25, 2.75), CAR12 (RR=2.56; 95% CI = 1.66, 3.95), and CAR16 (RR=2.21; 95% CI = 1.03, 4.73). Moreover, VC improved PAR2 (RR=1.47; 95% CI = 1.06, 2.04), PAR4 (RR=1.35; 95% CI = 1.02, 1.79), PAR8 (RR=1.60; 95% CI = 1.11, 2.31), and PAR12 (RR=1.70; 95% CI = 1.25, 2.30). There was no significant difference in the AE between the two groups. The study substantiates claims that VC products are effective in assisting with smoking cessation.

Efficacy and safety of Sahastara remedy for pain relief: A systematic review and meta-analysis of randomized controlled trials

The Sahastara (SHT) remedy is an herbal medicine that can be used as an alternative treatment for improving pain symptoms. The aim of this study was to evaluate the efficacy and safety of the SHT remedy for pain relief. PubMed, Scopus, ScienceDirect, TCI, and ThaiLis were systematically searched for relevant articles from inception to April 2021. We only included randomized clinical trials (RCTs) in which the efficacy and safety of the SHT remedy were compared with those of non-steroidal anti-inflammatory drugs (NSAIDs). Study selection, data extraction, and quality assessment were independently performed by two reviewers. The clinical therapeutic outcomes were the pain score, WOMAC score, Oswestry Disability Index score, 100 meters walk result, global assessment, and adverse events of the SHT remedy. The outcomes were assessed and pooled using a random-effects model. Heterogeneity was assessed using the I2 test. Four studies with 213 participants were included in the analysis. The efficacy of the SHT remedy was not different from that of NSAIDs in terms of the pain score (standardized mean difference [SMD] = -0.31; 95% CI = -1.26, 0.65; I2 = 91%), WOMAC score (SMD = 0.05; 95% CI = -0.30, 0.41; I2 = 0.0%), Oswestry Disability Index score (SMD = -0.41, 95% CI = -1.18, 0.35), 100 meters walk result (SMD = 0.31; 95% CI = -0.25, 0.87; I2 = 0.0%), and global assessment (relative risk = 0.85; 95% CI = 0.62, 1.16; I2 = 0.0%). Moreover, there were no statistically significant differences between the SHT remedy and NSAID treatment groups in terms of adverse events or liver function. This meta-analysis demonstrated that the SHT remedy is not different from NSAIDs in terms of clinical therapeutic efficacy and adverse events. However, larger and well-designed studies are needed to confirm this conclusion.

Effects of Triphala on Lipid and Glucose Profiles and Anthropometric Parameters: A Systematic Review

Aim.

The efficacy of triphala on lipid profile, blood glucose and anthropometric parameters and its safety were assessed.

Methods.

Databases such as PubMed, ScienceDirect, Web of Science, and Thai Library Integrated System (ThaiLIS) were systematically searched to review current evidence of randomized controlled trials (RCT) on triphala. RCTs investigating the safety and efficacy of triphala on lipid profile, blood glucose and anthropometric parameters were included. Study selection, data extraction, and quality assessment were performed independently by 2 authors.

Results.

Twelve studies on a total of 749 patients were included. The triphala-treated groups showed significantly reduced low-density lipoprotein-cholesterol, total cholesterol and triglyceride in 6 studies. Five RCTs demonstrated triphala-treated groups led to statistically significant decrease in body weight, body mass index and waist circumference of obese patients. Moreover, triphala significantly decreased fasting blood glucose level in diabetic patients but not in people without diabetes. No serious adverse event associated with triphala was reported during treatment.

Conclusions.

This review summarized a current evidence to show triphala might improve the lipid profile, blood glucose, the body weight, body mass index and waist circumference under certain conditions. However, large well-designed RCTs are required to confirm this conclusion.

Efficacy of red yeast rice extract on myocardial infarction patients with borderline hypercholesterolemia: A meta-analysis of randomized controlled trials

Red yeast rice (RYR) extract is widely used for improving cardiovascular outcomes and lipid profiles. However, RYR efficacy on cardiovascular outcomes in myocardial infarction (MI) patients remains unclear. This meta-analysis assessed efficacy of RYR extract in MI patients with borderline hypercholesterolemia. PubMed, CENTRAL, CINAHL, Scopus, Web of Science, and Clinicaltrials.gov were systematically searched from inception through May 2019 for relevant publications. Seven studies with 10,699 MI patients diagnosed with borderline hypercholesterolemia were included. Follow-up periods ranged from 4 weeks - 4.5 years and the studies were overall of high quality with low risk of bias. RYR extract (1,200 mg/day) reduced nonfatal MI (risk ratio (RR) = 0.42, 95% CI 0.34 to 0.52), revascularization (RR = 0.58, 95% CI 0.48 to 0.71), and sudden death (RR = 0.71, 95% CI 0.53 to 0.94). RYR extract also lowered LDL (weighted mean difference (WMD) = -20.70 mg/dL, 95% CI -24.51 to -16.90), TC (WMD = -26.61 mg/dL, 95% CI -31.65 to -21.58), TG (WMD = - 24.69 mg/dL, 95% CI -34.36 to -15.03), and increased HDL levels (WMD = 2.71 mg/dL, 95% CI 1.24 to 4.17). This meta-analysis indicated that RYR extract in MI patients with borderline hypercholesterolemia is associated with improved cardiovascular outcomes and lipid profiles.

A systematic review of the development and testing of additional dimensions for the EQ-5D descriptive system

Introduction: As the five dimensions of the EQ-5D might be insensitive to some populations or conditions, adding one or more specific 'bolt-on dimensions', to the EQ-5D may improve its validity and relevance for those groups. Various bolt-on dimensions have been identified and tested the effect on the psychometric performance and utility measurement. Therefore, this systematic review was to review all bolt-on dimensions and report the results of those two effects. Areas covered: Twelve studies were identified through PubMed, Scopus, and Web of Sciences from inception to January 2019. The bolt-on dimensions generally improved the EQ-5D's psychometric performance when compared with the standard version. However, evidence is lacking about the impact of bolt-on dimensions on responsiveness, reliability and known-groups validity. Evidence was also mixed for adding a sleep dimension, while interpersonal relationships did not promote a significant improvement on utility measurement. Expert opinion: Adding bolt-on dimensions could enhance the discriminative power and utility measurement of the EQ-5D; however, careful investigation of the sleep and interpersonal relationships is required since the evidence did not support a significant improvement. Further investigation of the identified bolt-on dimensions on all of the psychometric performance and the incremental utility scores derived from TTO is greatly encouraged.

Depression screening and advisory service provided by community pharmacist for depressive students in university

Background

Depressive symptom among adolescent is prevalent but advisory service for this symptom is limited, particularly in university.

Objectives

(1) To identify depressive students in health science faculties, (2) To evaluate the consequence of depression advisory service by community pharmacist, compared between a group counseling and an individual one.

Methods

A two-phase study was designed—a cross-sectional study followed by an experimental study. Health science students were screened by CES-D questionnaire. The prevalence and predictors of depressed mood were determined. Depressive students were then invited to the experimental study. Participants were assigned into 2 groups, by stratified random sampling, and followed up for 16 weeks. Group 1 received a group counselling, group 2 received an individual counselling from a trained pharmacist. Outcomes measured were the CES-D score and quality of life.

Results

The prevalence of depressed mood students was 13.7 % (195/1421). Students in year 2nd and year 3rd, nursing and medicine students, and GPA were strongly associated with the CES-D score (P < 0.05). Sixty-eight depressive students were assigned into the experiment. The CES-D scores of both groups were significantly reduced from the baseline (P < 0.001). The post-test score of group 2 was lower than group 1 (17.7 ± 4.5 vs 20.1 ± 4.6, P = 0.038). At week 16, both counselling types significantly increased mean score of physical health (P < 0.001) whereas score of mental health was increased significantly only by the individual counselling, from 37.9 ± 9.9 to 43.1 ± 8.4 (P = 0.036).

Conclusions

Depressive symptom among health science students is considerably high. Year of study, faculty and GPA are significant predictors of this disorder. Trained community pharmacists can effectively screen and provide advisory service. Individual counseling is more effective than using group advice.

Thai community pharmacist involvement in weight management in primary care to improve patient's outcomes

BACKGROUND

The community pharmacist has significant potential to assist in providing health advice aimed at the improvement outcomes pertaining to weight management, however, up to now, evidence regarding its effectiveness has been inconclusive. In Thailand, community pharmacy involvement in weight management is a novel idea and therefore needs an evaluation of its effectiveness.

OBJECTIVE

To examine essential outcomes, comparing the pharmacist's interventions with a routine weight management service provided at a primary care unit (PCU).

SETTING

Maha Sarakham province, Thailand.

METHODS

A randomized controlled trial was designed involving sixty-six obese patients randomly assigned to either the control group or the experimental group. Participants in the control group received group counselling from the PCU staff as usual, while those participants in the experimental group received one-on-one advice from a community pharmacist along with the weight loss handbook for self-study. Both groups were followed up and clinical outcomes were monitored four times at weeks 0, 4, 8, and 16. Eating behaviours and knowledge about overweight and obesity were measured twice, at weeks 0 and 16.

MAIN OUTCOME MEASURE

Clinical outcomes included weight, waist circumference, body mass index, measured by standard medical devices. Eating behaviours were measured by the theory of planned behaviour (TPB) questionnaire. Knowledge was measured by a questionnaire focusing on the subjects' level of understanding regarding overweight and obesity issues.

RESULTS

Neither group showed improvement in clinical outcomes. The TPB average sum score significantly increased from baseline in the experimental group in terms of intention to perform healthy dieting behaviour, subjective norm, behavioural beliefs, normative beliefs, and control beliefs. (P < 0.05) In the control group, scores increased significantly from the baseline only for behavioural beliefs. (P < 0.05) Moreover, the knowledge score in experimental group increased significantly from 6.42 ± 1.94 to 8.75 ± 0.68 (P < 0.05).

CONCLUSION

Thai community pharmacists can help to improve both eating behaviour and knowledge about weight and obesity among obese patients. However, since the effect on clinical outcomes is unclear, a long-term study is still needed.