BackgroundThe concept of Pharmaceutical Care is operationalized through pharmaceutical professional services, which are patient-oriented to optimize their pharmacotherapy and to improve clinical outcomes. ObjectiveThe objective of this study was to estimate the incremental cost-effectiveness ratio (ICER) of a medication review with follow-up (MRF) service for older adults with polypharmacy in Spanish community pharmacies, against the alternative of having their medication dispensed normally. MethodsThe study was designed as a cluster randomized controlled trial, and was carried out over a time horizon of six months. The target population was older adults with polypharmacy, defined as individuals taking five or more medicines per day. The study was conducted in 178 community pharmacies in Spain. Costutility analysis adopted a health service perspective. Costs were in euros at 2014 prices and the effectiveness of the intervention was estimated as QALYs. In order to analyze the uncertainty of ICER results, we performed a nonparametric bootstrapping with 5,000 replications. ConclusionMRF service is an effective intervention for optimizing prescribed medication and improving the quality of life in older adults with polypharmacy in community pharmacies. The results from the cost-utility analysis suggest that MRF service is cost effective. Key points for decision makers-Polypharmacy is a particular concern in older adult populations, and is associated with negative health outcomes.-Medication review with follow-up is a service that attempts to optimize pharmacotherapy, not just by focusing on the process of the use of medication, but also by improving clinical outcomes for older adults.-Medication review with follow-up service is an effective intervention for optimizing prescribed medication and improving the quality of life of older adults with polypharmacy in community pharmacies. Compared with usual dispensing, this service is cost effective.3

AIMSThe aims were to assess the impact of a medication review with follow-up (MRF) service provided in community pharmacy to aged polypharmacy patients on the number of medication-related hospital admissions and to estimate the effect on hospital costs. METHODSThis was a sub-analysis of a cluster randomized controlled trials carried out in 178 community pharmacies in Spain. Pharmacies in the intervention group (IG) provided a comprehensive medication review during 6 months. Pharmacists in the comparison group (CG) delivered usual care. For the purposes of this sub-analysis, an expert panel of three internal medicine specialists screened the hospitalizations occurring during the main study, in order to identify medication-related hospitalizations. Inter-rater reliability was measured using Fleiss's kappa. Hospital costs were calculated using diagnosis related groups. RESULTSOne thousand four hundred and three patients were included in the main study and they had 83 hospitalizations. Forty-two hospitalizations (50.6%) were medicine-related, with a substantial level of agreement among the experts (kappa = 0.65, 95% CI 0.52, 0.78, P < 0.01). The number of medication-related hospitalizations was significantly lower in patients receiving MRF (IG 11, GC 31, P = 0.042). The probability of being hospitalized was 3.7 times higher in the CG (odds ratio 3.7, 95% CI 1.2, 11.3, P = 0.021). Costs for a medicine-related hospitalization were €6672. Medication-related hospitalization costs were lower for patients receiving MRF [IG: €94 (SD 917); CG: €301 (SD 2102); 95% CI 35.9, 378.0, P = 0.018]. CONCLUSIONMRF provided by community pharmacists might be an effective strategy to balance the assurance of the benefit from medications and the avoidance of medication-related hospitalizations in aged patients using polypharmacy. British Journal of Clinical Pharmacology WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Medication-related hospital admissions are a significant problem in aged polypharmacy patients.• The evidence of the impact of professional pharmacy services on hospital admissions remains uncertain. WHAT THIS STUDY ADDS• The percentage of medication-related hospital admissions was significantly lower in patients receiving medication review with follow-up (26.2% vs. 73.8%, P < 0.05).• The probability of being hospitalized was 3.7 times higher in the comparison group (CG) than in the intervention group (IG) (P < 0.05).• Medication-related hospitalization costs were lower for patients receiving MRF [IG: €94 vs. CG: €301; P = 0.018].

The MRF provided health benefits to patients and substantial cost savings to the NHS. Investment in this service would represent an efficient use of healthcare resources.

The aim was to determine whether professional pharmacy services (PPS) provided to ambulatory patients attending community pharmacy are cost-effective compared with usual care (UC). Areas covered: MEDLINE, Web of Knowledge, Scopus, Cochrane Library and Centre for Reviews and Dissemination databases were searched, and the risk of bias of randomized controlled trials, and the methodological quality of economic evaluations was assessed. A total of 17 economic evaluations of 13 studies were included. Seven studies were classified as high-, three as medium- and three as low-quality. PPS were more effective and less costly than UC in four studies; seven studies concluded that PPS were more effective and more costly and two studies concluded that the service was as effective as the UC, with higher and lower costs. Expert commentary: Although the uncertainty was variable among the studies, a general trend towards the cost-effectiveness of PPS was observed. Decision makers are encouraged to consider the feasibility of implementing PPS.

Objective To evaluate the impact of health professionals’ intervention on adherence to statins, the influence on total cholesterol levels, and lifestyle patterns in patients with hypercholesterolemia and analyze the differences according to the center of recruitment. Study Setting Forty‐six community pharmacies and 50 primary care centers of Spain. Study Design Randomized controlled trial design (n = 746). Patients were assigned into adherent (ADH) or nonadherent group depending on their initial adherence to statins. Nonadherent patients were randomly assigned to intervention (INT) or nonintervention (NOINT) group. Patients enrolled in the INT group received an intervention depending on the cause of nonadherence. Patients in the ADH and NOINT groups received usual care. Intention‐to‐treat (ITT) analysis was performed with multiple imputation to replace the missing data. Data Collection Adherence, total cholesterol levels, and lifestyle behaviors. Findings The odds of becoming adherent during the 6 months was higher in the INT group compared to the NOINT group (OR = 1,49; 95% CI: 1.30‐1.76; P < 0.001), especially in the community pharmacy group (OR = 2.34; 95% CI: 1.81‐3.03; P < 0.001). Adherent patients showed lower values of total cholesterol compared with nonadherent patients at baseline (ADH: 200.3 mg/dL vs NOADH: 216.7 mg/dL; P < 0.001) and at the endpoint (ADH: 197.3 mg/dL vs NOADH: 212.2 mg/dL; P < 0.001). More patients enrolled in the INT group practices exercise at the end of the study (INT: +26.6 percent; P = 0.002), and a greater number of patients followed a diet to treat hypercholesterolemia (+30.2 percent; P < 0.001). Conclusions The intervention performed by health professionals, especially by community pharmacists, improved adherence to statins by hypercholesterolemic patients, and this improvement in adherence was accompanied by a reduction in total cholesterol levels and a healthier lifestyle.

A511 mize selection bias. Patients in both groups were required to be at least age 18 years, with continuous medical and pharmacy benefits 1 year before, and 1 year after the index date. One-to-one propensity score matching (PSM) was used to compare health care costs and utilizations during the follow-up period between the menopausal and the comparison groups, and were adjusted for baseline demographic and clinical characteristics. Results: After risk adjustment by PSM, a total of 67,740 patients in each cohort were matched. More menopausal patients had inpatient admissions (15.18% vs. 11.89%, p< 0.0001) and other service (99.98% vs. 90.29%, p< 0.0001) and pharmacy visits (86.55% vs. 71.23%, p< 0.0001) compared to those without menopause. Menopausal patients also incurred significantly higher other service visit ($11,215 vs. $8,812, p< 0.0001) and pharmacy costs ($2,448 vs. $1,878, p< 0.0001) than comparison patients. ConClusions: In the U.S. Medicaid program, menopausal patients had higher health care utilization and incurred higher costs than those without menopause, highlighting the economic burden of the disease.objeCtives: Infantile Hemangioma (IH) is one of the most common childhood benign tumours. Recent studies have demonstrated the success of propranolol for involution of IH and the higher clinically effective and safe compared with corticosteroids. The purpose of this study is to estimate the cost-utility of propranolol, a new medicinal product authorized for this specific paediatric indication (3.75 mg/ mL, oral solution) versus corticosteroids (5.00 mg, tablets), used in clinical practice in absence of other authorised therapies of proliferating IH requiring systemic treatment. Methods: A life-time (30 years) mixed decision tree and Markov model has been developed to describe the pathway of infants with IH and to assess costs and outcomes (Quality-Adjusted Life Years -QALYs -gained) from the perspective of the Italian National Health Service (INHS). Clinical inputs derive from the manufacturer's pivotal trial and literature review, validated by key clinicians in Italy. The economic evaluation considers direct medical costs associated with IH (drug acquisition, hospital admissions and outpatient visits) derived from public sources. The atopic dermatitis as a proxy for IH utilities, the Infants Dermatitis Quality of Life Index and the Children's Dermatology Life Quality Index were used to estimate quality of life. Probabilistic sensitivity analyses (PSA) were performed to investigate model parameter uncertainties. Costs and health benefits have been discounted at an annual rate of 3.00%. Results: The cumulative costs are € 2,399.32 and € 1,859.68 while cumulative QALYs are 19.11 and 18.95 for propranolol and for corticosteroids respectively, corresponding to an ICUR of € 3,372.75/QALY. PSA results suggest that 94.60% of the 1000 iterations fall within a € 30,000 cost-effectiveness threshold considered acceptable for a marginal unit of effectiveness. ConClusions: The propranolol (3.75 mg/mL, oral solutio...

Background Medication review with follow-up (MRF) is a professional pharmacy service proven to be cost-effective. Its broader implementation is limited, mainly due to the lack of evidence-based implementation programs that include economic and financial analysis. Objective To analyse the costs and estimate the price of providing and implementing MRF. Setting Community pharmacy in Spain. Method Elderly patients using poly-pharmacy received a community pharmacist-led MRF for 6 months. The cost analysis was based on the time-driven activity based costing model and included the provider costs, initial investment costs and maintenance expenses. The service price was estimated using the labour costs, costs associated with service provision, potential number of patients receiving the service and mark-up. Main outcome measures Costs and potential price of MRF. Results A mean time of 404.4 (SD 232.2) was spent on service provision and was extrapolated to annual costs. Service provider cost per patient ranged from €196 (SD 90.5) to €310 (SD 164.4). The mean initial investment per pharmacy was €4594 and the mean annual maintenance costs €3,068. Largest items contributing to cost were initial staff training, continuing education and renting of the patient counselling area. The potential service price ranged from €237 to €628 per patient a year. Conclusion Time spent by the service provider accounted for 75-95% of the final cost, followed by initial investment costs and maintenance costs. Remuneration for professional pharmacy services provision must cover service costs and appropriate profit, allowing for their long-term sustainability.

Introduction Non‐adherence is a major problem among patients with chronic diseases. Community pharmacists are ideally positioned to detect non‐adherence and to provide patient‐centred interventions. Objective To conduct a systematic review of the impact of community pharmacist interventions on patient adherence to lipid lowering medication (LLM) prescriptions and clinical outcomes. Search method Five databases (MEDLINE, Cochrane Library, Science Direct, Scopus, and Web of Knowledge) were searched systematically to identify relevant reports published by December 2019. Study quality was assessed with the Cochrane risk of bias (RoB 2.0) tool. Selection criteria Controlled trials in which community pharmacists conducted an intervention to improve patient adherence to LLM and clinical outcomes were evaluated. Main results Five studies (2408 participants) were included in the qualitative analysis. Four studies (n = 2266) were pooled in the meta‐analysis. Participants in the intervention group (IG) had better adherence than those in the control group (CG) [odds ratio (OR) = 1.67; 95% confidence interval (CI) 1.38‐2.02; P < 0.001; I2 = 54%]. Better adherence rates were obtained when adherence was measured with validated questionnaires than when medication‐possession ratio (MPR) measurements were used. Total cholesterol (TC) levels were not included in the meta‐analysis due to data variability among the studies. Conclusions Pharmacist‐led intervention can improve LLM adherence, but its influence on clinical outcomes, including lipid level control, remains to be clarified.