Economic evaluation of pharmacists prescribing for minor ailments in Ontario, Canada: a cost-minimization analysis

Abstract

Objectives The objective of this study was to use a decision-analytic model to examine the potential economic impact of establishing a remunerated programme for pharmacists prescribing for minor ailments (PPMA) in Ontario, Canada. Methods A novel decision tool was developed to assess the economic impact of pharmacists prescribing for upper respiratory tract infections (URTIs), contact dermatitis (CD) and conjunctivitis by performing a cost-minimization analysis from a public payer perspective. Two prescribing strategies were compared: (1) PPMA, where patients may seek care from pharmacists or physicians, and (2) the usual care model (UCM), where all patients receive care from physicians. Two remuneration models for the PPMA strategy were also compared: (1) a prescription-detached scenario (PDS), where pharmacists were remunerated CAD$18.00 for each consultation, and (2) a Prescription-Attached Scenario (PAS), where pharmacists were only remunerated if a decision to prescribe was made. Key findings At a service uptake rate of 38% for the PDS, the PPMA model led to savings of $7.51, $4.08 and $5.15 per patient for URTIs, CD and conjunctivitis, respectively. Per 30 000 patients, the PPMA model for these minor ailments was projected to lead to cumulative reductions in visits to the emergency department, family physician and walk-in clinics by 799, 3677 and 5090, respectively. Conclusions The results of the study strongly suggest that enabling community pharmacists to assess and prescribe for minor ailments could potentially lead to large savings for the government in Ontario, Canada. In 100% of the PAS scenarios simulated, pharmacists as prescribers led to cost savings.

Self-care and minor ailments: The view from Canada

“…The introduction of pharmacist prescribing programs for minor ailments in Canada over the last 15 years has brought about a profound transformation in the healthcare landscape, improving patient access to timely and cost-effective healthcare services, reducing the burden on primary care facilities, decreasing wait times and increasing patient satisfaction levels, leading to savings for governments. 49 , 50 , 51 However, the effects of these programs on patient self-care and self-medication remain uncharted territory. As of July 2023, pharmacist prescribing for minor ailments is a reality across all 10 Canadian provinces.…”

Community pharmacist‐provided test and treat programs for acute infectious conditions

“…46 Various studies in countries or provinces with public payers have indicated that pharmacist test and treat programs for minor ailments such as uncomplicated UTIs and hepatitis C would be cost saving for the public system, illustrating the potential benefits from widespread acceptance of pharmacists as providers and the creation of sustainable reimbursement models. 37,47,48 One pilot study in England where patients had to pay out of pocket for pharmacist UTI testing and treatment service that they could have received at a national healthcare system clinic free of charge found that the majority of patients who were tested and received treatment would have gone to their general practitioner if the pharmacy service was not available. 49 United States payers should be incentivized to promote pharmacy test and treatment services for acute conditions and advocate for the removal of regulatory barriers limiting the implementation of sustainable programs.…”

“…A cost‐effective analysis comparing treatment of adult group A streptococcus pharyngitis patients by community pharmacists with various physician provider treatments found pharmacist treatment to be the most cost effective using a cost threshold of $55.56 46 . Various studies in countries or provinces with public payers have indicated that pharmacist test and treat programs for minor ailments such as uncomplicated UTIs and hepatitis C would be cost saving for the public system, illustrating the potential benefits from widespread acceptance of pharmacists as providers and the creation of sustainable reimbursement models 37,47,48 . One pilot study in England where patients had to pay out of pocket for pharmacist UTI testing and treatment service that they could have received at a national healthcare system clinic free of charge found that the majority of patients who were tested and received treatment would have gone to their general practitioner if the pharmacy service was not available 49 .…”

Increased self-reported pharmacist prescribing during the COVID-19 pandemic: Using the Theoretical Domains Framework to identify barriers and facilitators to prescribing

“… 7 Further evidence of cost savings of pharmacist prescribing for minor ailments was identified in a recent modelling study from Ontario, Canada, that projected savings of $4.08 to $7.51 per patient depending on the minor ailment. 8 Despite the well documented benefits of pharmacist prescribing, implementation has been lower than expected. 9 …”