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Cost-utility analysis of physician-pharmacist collaborative intervention for treating hypertension compared with
Puttarin Kulchaitanaroaj1, John M Brooks, Nathorn Chaiyakunapruk
1aDepartment of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA bHealth Economics Research Group (HERG), Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom cDepartment of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA dSchool of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia eCenter of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand fSchool of Pharmacy, University of Wisconsin, Madison, Wisconsin, USA gSchool of Population Health, University of Queensland, Brisbane, Queensland, Australia hDepartment of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA.
Insights
Physician-pharmacist collaboration improves long-term outcomes for hypertension treatment. This team-based care strategy is cost-effective, especially for high-risk patients, offering significant value per quality-adjusted life year gained.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Pharmacoeconomics
Background:
- Essential hypertension management requires effective long-term strategies.
- Physician-pharmacist collaborative interventions offer a potential avenue for improved patient outcomes.
- Assessing the cost-effectiveness of such interventions is crucial for healthcare decision-making.
Purpose of the Study:
- To estimate the long-term costs and quality-adjusted life years (QALYs) of a physician-pharmacist collaborative intervention compared to physician management alone for essential hypertension.
- To determine the cost-effectiveness of this collaborative approach in treating hypertension.
Main Methods:
- A Markov model cohort simulation was employed to predict cardiovascular events (acute coronary syndrome, stroke, heart failure) over a lifetime.
- Patient data from two cluster randomized controlled trials were used, with vascular disease prediction based on Framingham risk equations.
- Costs were analyzed from a payer perspective, and outcomes were measured in QALYs, with both discounted at 3%.
Main Results:
- The physician-pharmacist collaborative intervention resulted in an incremental cost of $26,807.83 per QALY gained (0.14 QALYs gained).
- The intervention demonstrated the greatest benefit for high-risk patients, moderate benefit for trial patients, and the lowest benefit for low-risk patients.
- The intervention was found to be cost-effective in 48.6% of simulations if a payer is willing to pay $50,000 per QALY gained.
Conclusions:
- Team-based care, specifically physician-pharmacist collaboration, is a cost-effective strategy for managing essential hypertension.
- The intervention's cost-effectiveness is most pronounced in high-risk patient populations.
- This collaborative model represents a valuable approach to improving hypertension treatment and patient outcomes.
Objective:
To estimate long-term costs and outcomes attributable to a physician-pharmacist collaborative intervention compared with physician management alone for treating essential hypertension.
Methods:
A Markov model cohort simulation with a 6-month cycle length to predict acute coronary syndrome, stroke, and heart failure throughout lifetime was performed. A cohort of 399 patients was obtained from two prospective, cluster randomized controlled clinical trials implementing physician-pharmacist collaborative interventions in community-based medical offices in the Midwest, USA. Framingham risk equations and other algorithms were used to predict the vascular diseases. SBP reduction due to the interventions deteriorated until 5 years. Direct medical costs using a payer perspective were adjusted to 2015 dollar value, and the main outcome was quality-adjusted life years (QALYs); both were discounted at 3%. The intervention costs were estimated from the trials, whereas the remaining parameters were from published studies. A series of sensitivity analyses including changing patient risks of vascular diseases, probabilistic sensitivity analysis, and a cost-effectiveness acceptability curve were performed.
Results:
The lifetime incremental costs were $26 807.83 per QALY (QALYs gained = 0.14). The intervention provided the greatest benefit for the high-risk patients, moderate benefit for the trial patients, and the lowest benefit for the low-risk patients. If a payer is willing to pay $50 000 per QALY gained, in 48.6% of the time the intervention would be cost-effective.
Conclusion:
Team-based care such as a physician-pharmacist collaboration appears to be a cost-effective strategy for treating hypertension. The intervention is most cost-effective for high-risk patients.
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