Cost-Effectiveness of a Community Pharmacist Intervention in Patients with Depression: A Randomized Controlled Trial (PRODEFAR Study)

Abstract

BackgroundNon-adherence to antidepressants generates higher costs for the treatment of depression. Little is known about the cost-effectiveness of pharmacist's interventions aimed at improving adherence to antidepressants. The study aimed to evaluate the cost-effectiveness of a community pharmacist intervention in comparison with usual care in depressed patients initiating treatment with antidepressants in primary care.MethodsPatients were recruited by general practitioners and randomized to community pharmacist intervention (87) that received an educational intervention and usual care (92). Adherence to antidepressants, clinical symptoms, Quality-Adjusted Life-Years (QALYs), use of healthcare services and productivity losses were measured at baseline, 3 and 6 months.ResultsThere were no significant differences between groups in costs or effects. From a societal perspective, the incremental cost-effectiveness ratio (ICER) for the community pharmacist intervention compared with usual care was €1,866 for extra adherent patient and €9,872 per extra QALY. In terms of remission of depressive symptoms, the usual care dominated the community pharmacist intervention. If willingness to pay (WTP) is €30,000 per extra adherent patient, remission of symptoms or QALYs, the probability of the community pharmacist intervention being cost-effective was 0.71, 0.46 and 0.75, respectively (societal perspective). From a healthcare perspective, the probability of the community pharmacist intervention being cost-effective in terms of adherence, QALYs and remission was of 0.71, 0.76 and 0.46, respectively, if WTP is €30,000.ConclusionA brief community pharmacist intervention addressed to depressed patients initiating antidepressant treatment showed a probability of being cost-effective of 0.71 and 0.75 in terms of improvement of adherence and QALYs, respectively, when compared to usual care. Regular implementation of the community pharmacist intervention is not recommended.Trial RegistrationClinicalTrials.gov NCT00794196

Pharmacy Practice Research Methods

“…This is partly because such evaluations are often required by payers of pharmaceutical services (Rawlins et al 2010;Committee PBA 2014). While a number of studies reporting pharmacy practice research have included costs associated with pharmacy services (Branham et al 2013;Lucca et al 2012;Desborough et al 2012;Kopp et al 2007;Hilleman et al 2004;Zaidi et al 2003;Crowson et al 2002;Devlin et al 1997;Dranitsaris et al 1995), the robust use of pharmacoeconomic analysis is limited (Saokaew et al 2013;Rubio-Valera et al 2013;Aspinall et al 2013;Weant et al 2009;Chisholm et al 2000).…”

“…Applying economic evaluation to pharmacists' interventions was common in early studies (Kopp et al 2007;Zaidi et al 2003;Crowson et al 2002;Devlin et al 1997;Chuang et al 1994;Cooper 1997;Cowper et al 1998), whereas recent studies focus more on disease-specific contribution of the pharmacists' role (Rubio-Valera et al 2013;Aspinall et al 2013;Weant et al 2009;Cies and Varlotta 2013;Gray et al 2007;van Boven et al 2014;Johnson 2009;Klepser et al 2012;Perraudin et al 2013;Thavorn and Chaiyakunapruk 2008). A bulk of published economic evaluations of pharmacists' interventions have been conducted within hospital settings (Kopp et al 2007;Zaidi et al 2003;Crowson et al 2002;Devlin et al 1997;Chuang et al 1994;Cooper Analysis to identify the particular option that will deliver the best utilisation of existing resources.…”

“…However, most older studies were focused on a particular aspect of disease management instead of on the pharmacist solely managing a disease or condition (Dranitsaris et al 1995;Mutchie et al 1979). A number of recent studies have investigated the cost-effectiveness of pharmacist-managed care for a variety of disease states such as pharmacist-managed smoking-cessation clinics (Thavorn and Chaiyakunapruk 2008), asthma program (Chan and Wang 2004), diabetes and heart disease (Branham et al 2013), depression clinics (Rubio-Valera et al 2013) and anaemia management in end stage renal disease (Aspinall et al 2013).…”

“…Compared to the economic evaluations of pharmacists' interventions, most recent studies evaluating pharmacists' impact on disease management have employed formal pharmacoeconomic analysis including sensitivity analysis (Rubio-Valera et al 2013;Aspinall et al 2013;Thavorn and Chaiyakunapruk 2008). Sensitivity analysis is where researchers modify the cost of different study variables to assess the cost-effectiveness of a particular intervention under different scenarios (Drummond et al 2005).…”

“…Another feature of published pharmacoeconomic studies in pharmacist-managed disease states is the detailed description of cost-effectiveness modelling and associated costs and consequences estimations (Rubio-Valera et al 2013;Aspinall et al 2013;Thavorn and Chaiyakunapruk 2008). An overarching aim of publishing scientific research is to contribute to the existing scientific literature so others can benefit from the literature.…”