Cost Effectiveness of Support for People Starting a New Medication for a Long-Term Condition Through Community Pharmacies: An Economic Evaluation of the New Medicine Service (NMS) Compared with Normal Practice

Abstract

Background The English community pharmacy New Medicine Service (NMS) significantly increases patient adherence to medicines, compared with normal practice. We examined the cost effectiveness of NMS compared with normal practice by combining adherence improvement and intervention costs with the effect of increased adherence on patient outcomes and healthcare costs. Methods We developed Markov models for diseases targeted by the NMS (hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary disease, asthma and antiplatelet regimens) to assess the impact of patients' nonadherence. Clinical event probability, treatment pathway, resource use and costs were extracted from literature and costing tariffs. Incremental costs and outcomes associated with each disease were incorporated additively into a composite probabilistic model and combined with adherence rates and intervention costs from the trial. Costs per extra quality-adjusted life-year (QALY) were calculated from the perspective of NHS England, using a lifetime horizon. Results NMS generated a mean of 0.05 (95% CI 0.00-0.13) more QALYs per patient, at a mean reduced cost of -£144 (95% CI -769 to 73). The NMS dominates normal practice with a probability of 0.78 [incremental cost-effectiveness ratio (ICER) -£3166 per QALY]. NMS has a 96.7% probability of cost effectiveness compared with normal practice at a willingness to pay of £20,000 per QALY. Sensitivity analysis demonstrated that targeting each disease with NMS has a probability over 0.90 of cost effectiveness compared with normal practice at a willingness to pay of £20,000 per QALY.

‘I expected just to walk in, get my tablets and then walk out’: on framing new community pharmacy services in the English healthcare system

“…Recent work indicates the NMS increases patient adherence to a new medicine by about 10% when compared with normal practice and increases health gain at reduced overall cost (Elliott et al . ). This paper offers recommendations so service improvements can be made to ensure the service realises its full potential.…”

“…In light of these findings, policy and professional assumptions that suggest patients can be categorised and treated as a homogenous group requires reconsideration and service innovation so that a more personalised care approach can be introduced. Recent work indicates the NMS increases patient adherence to a new medicine by about 10% when compared with normal practice and increases health gain at reduced overall cost (Elliott et al 2017). This paper offers recommendations so service improvements can be made to ensure the service realises its full potential.…”

Cost effectiveness of the New Medicine Service

“…A study has examined the cost effectiveness of NMS compared with normal practice by combining adherence improvement and intervention costs with the effect of increased adherence on patient outcomes and healthcare costs. 2 …”

“…Analysis models were developed for diseases targeted by the NMS to assess the impact of patients’ non-adherence. 2 Clinical event probability, treatment pathway, resource use and costs were extracted from literature and costing tariffs. Costs per extra quality-adjusted life-year (QALY) were calculated from the perspective of NHS England using a lifetime horizon.…”

“…2 The NMS dominated normal practice with a probability of 0.78 (incremental cost-effectiveness ratio [ICER] −£3,166 per QALY). NMS had a 96.7% probability of cost effectiveness compared with normal practice at a willingness to pay of £20,000 per QALY.…”