Healthcare cost savings through hospital pharmacist-collaborative care in heart failure: A microsimulation study

Heart failure (HF) is associated with high hospitalization rates and substantial healthcare costs. Pharmacist-collaborative interventions in HF can optimize medication management and have been shown to reduce hospitalizations, but their economic impact in hospital settings remains unclear.

Estimate the healthcare payer cost of pharmacist-collaborative care in patients attending a HF clinic at a large Belgian hospital.

A microsimulation model was developed to estimate the healthcare payer cost of pharmacist-collaborative care in patients attending a HF clinic at a large Belgian hospital. The model compared total avoided hospitalization costs and pharmacist-related costs over a one-year horizon. Patient-level variability and parameter uncertainty were incorporated using Monte Carlo simulation. Input parameters, including number needed to treat (NNT) to avoid a hospitalization, pharmacist full-time equivalent (FTE) and annual cost, hospitalization cost, and weekly patient throughput, were represented by probabilistic distributions. Cost impact was summarized as mean, median and 95% credible intervals (CrI). Determinants of cost impact were explored using multivariable linear regression. The NNT threshold for cost neutrality was estimated.

Across all simulations, the intervention achieved cost savings in 96.2% of scenarios, with mean annual savings of €93,899 (median €88,834; 95% CrI: €-4,350 to €226,549). Regression analysis indicated that each additional patient managed per week increased annual savings by €16,760 (p < 0.001), and each €1 increase in hospitalization cost increased savings by €17.25 (p < 0.001). In contrast, each one-unit increase in NNT was associated with a decrease in cost savings of €2,115 (p < 0.001). The patient-level NNT required for cost neutrality was 74.

Pharmacist-collaborative interventions in HF care are highly likely to generate cost savings, particularly in HF clinics with higher patient throughput or settings with higher hospitalization costs. These quantitative thresholds provide practical guidance for the allocation and scaling of pharmacist resources in multidisciplinary HF programs.