Cost-benefit analysis of pharmacist interventions over 36 months in a university hospital

Abstract

OBJECTIVE: To perform a cost-benefits analysis of a clinical pharmacy (CP) service implemented in a Neurology ward of a tertiary teaching hospital. METHODS: This is a cost-benefit analysis of a single arm, prospective cohort study performed at the adult Neurology Unit over 36 months, which has evaluated the results of a CP service from a hospital and Public Health System (PHS) perspective. The interventions were classified into 14 categories and the costs identified as direct medical costs. The results were analyzed by the total and marginal cost, the benefit-cost ratio (BCR) and the net benefit (NB). RESULTS: The total 334 patients were followed-up and the highest occurrence in 506 interventions was drug introduction (29.0%). The marginal cost for the hospital and avoided cost for PHS was US$182±32 and US$25,536±4,923 per year; and US$0.55 and US$76.4 per patient/year. The BCR and NB were 0.0, -US$26,105 (95%CI -31,850 – -10,610), -US$27,112 (95%CI -33,160–11,720) for the hospital and; 3.0 (95%CI 1.97–4.94), US$51,048 (95%CI 27,645–75,716) and, 4.6 (95%CI 2.24–10.05), US$91,496 (95%CI 34,700–168,050; p < 0.001) for the PHS, both considering adhered and total interventions, respectively. CONCLUSIONS: The CP service was not directly cost-benefit at the hospital perspective, but it presented savings for forecast cost related to the occurrence of preventable morbidities, measuring a good cost-benefit for the PHS.

Economic impact of clinical pharmacist interventions in a general tertiary hospital in Qatar

“…However, similar to our findings, the addition and discontinuation of medications, and change in doses (i.e. incorrect dose, increased dose or decreased dose) were the top categories of interventions associated with the cost saving [29]. Another retrospective study, by Chen et al [19], was conducted in a nephrology ward and found that deployment of clinical pharmacists' interventions yielded cost savings of USD 144,138, and cost avoidance of ADEs of USD 7,342,200, which are higher than in our findings.…”

“…Therefore, our study findings may not be practical to compare with previous studies conducted in different settings, given the differences among clinical practices and healthcare systems across the globe. For example, Cazarim et al [ 29 ], in a prospective cohort study performed at a neurology unit with 506 interventions, reported that the total added cost of interventions resulted in an annual average of USD 1,158, and the annual cost avoided was USD 25,536. These values are lower than those in our findings, which is expected given the fact that the analysis was limited to interventions that occurred in the neurology department, and this might underestimate the overall economic influence of clinical pharmacists.…”

The participation of clinical pharmacists in the treatment of patients with central nervous system infection can improve the effectiveness and appropriateness of anti-infective treatments: a retrospective cohort study

“…From the hospital’s perspective, pharmacy services have not reduced direct healthcare costs. Still, it presented savings for forecast costs related to preventable morbidities, measuring an excellent cost-benefit ratio for the public health sector ( Cazarim et al, 2020 ). The pharmacist services also did not significantly reduce the LOS, which is inconsistent with the literature ( Nielsen et al, 2017 ).…”