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Cost-effectiveness of pharmacist care for managing hypertension in Canada
Carlo Marra1, Karissa Johnston1, Valerie Santschi1
1School of Pharmacy (Marra), University of Otago, New Zealand; Broadstreet Health Economics & Outcomes Research (Johnston), Vancouver, BC; the School of Nursing Sciences (Santschi), University of Applied Sciences Western Switzerland, Switzerland; and Faculty of Medicine and Dentistry (Tsuyuki), University of Alberta, Edmonton, Alberta.
Insights
Pharmacist-led hypertension care significantly reduces blood pressure and cardiovascular events, offering cost savings. This intervention is economically dominant, improving health outcomes and reducing healthcare expenses.
Area of Science:
- Health Economics
- Cardiovascular Medicine
- Pharmacotherapy
Background:
- Hypertension contributes to over 50% of heart disease and stroke cases globally.
- It accounts for approximately 10% of direct global medical costs.
- Pharmacist interventions, including prescribing, have shown significant blood pressure reduction (e.g., 18.3 mmHg systolic).
Purpose of the Study:
- To evaluate the economic impact of pharmacist-led hypertension intervention in Canada.
- To assess the cost-effectiveness of pharmacist care compared to usual care.
Main Methods:
- A Markov cost-effectiveness model was utilized to project long-term outcomes.
- The model incorporated Framingham and other risk equations for cardiovascular and renal disease.
- A range of systolic blood pressure reductions (7.6-18.3 mmHg) were analyzed, considering health outcomes, costs, and quality of life.
Main Results:
- A 18.3 mmHg systolic blood pressure reduction yielded 0.21 fewer cardiovascular events per person.
- The intervention resulted in 0.3 additional life-years and 0.4 additional quality-adjusted life-years.
- Estimated lifetime cost savings were $6,364 per person, with the intervention being economically dominant.
Conclusions:
- Pharmacist intervention for hypertension was consistently effective and cost-saving across sensitivity analyses.
- Comprehensive pharmacist care, including education and prescribing, offers significant health benefits and cost savings.
- This intervention has important public health implications for managing hypertension in Canada.
Background:
More than half of all heart disease and stroke are attributable to hypertension, which is associated with approximately 10% of direct medical costs globally. Clinical trial evidence has demonstrated that the benefits of pharmacist intervention, including education, consultation and/or prescribing, can help to reduce blood pressure; a recent Canadian trial found an 18.3 mmHg reduction in systolic blood pressure associated with pharmacist care and prescribing. The objective of this study was to evaluate the economic impact of such an intervention in a Canadian setting.
Methods:
A Markov cost-effectiveness model was developed to extrapolate potential differences in long-term cardiovascular and renal disease outcomes, using Framingham risk equations and other published risk equations. A range of values for systolic blood pressure reduction was considered (7.6-18.3 mmHg) to reflect the range of potential interventions and available evidence. The model incorporated health outcomes, costs and quality of life to estimate an overall incremental cost-effectiveness ratio. Costs considered included direct medical costs as well as the costs associated with implementing the pharmacist intervention strategy.
Results:
For a systolic blood pressure reduction of 18.3 mmHg, the estimated impact is 0.21 fewer cardiovascular events per person and, discounted at 5% per year, 0.3 additional life-years, 0.4 additional quality-adjusted life-years and $6,364 cost savings over a lifetime. Thus, the intervention is economically dominant, being both more effective and cost-saving relative to usual care.
Discussion:
Across a range of one-way and probabilistic sensitivity analyses of key parameters and assumptions, pharmacist intervention remained both effective and cost-saving.
Conclusion:
Comprehensive pharmacist care of hypertension, including patient education and prescribing, has the potential to offer both health benefits and cost savings to Canadians and, as such, has important public health implications.
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