Economic Evaluations of Clinical Pharmacy Services: 2006–2010

Abstract

Studies have consistently evidenced the positive clinical, economic, and humanistic benefits of pharmacist-directed patient care in a variety of settings. Given the vast differences in clinical outcomes associated with evaluated clinical pharmacy services (CPS), more detail as to the nature of the CPS is needed to better understand observed differences in economic outcomes. With the growing trend of outpatient pharmacy services, these economic evaluations serve as viable decision-making tools in choosing the most effective and cost-effective pharmacy programs. We previously conducted three systematic reviews to evaluate the economic impact of CPS from 1988 to 2005. In this systematic review, our objectives were to describe and evaluate the quality of economic evaluations of CPS published between 2006 and 2010, with the goal of informing administrators and practitioners as to their cost-effectiveness. We searched the scientific literature by using the Medline, International Pharmaceutical Abstracts, Embase, and Cumulative Index to Nursing and Allied Health Literature databases to identify studies describing CPS published from 2006 to 2010. Studies meeting our inclusion criteria (original research articles that evaluated CPS and described economic and clinical outcomes) were reviewed by two investigators. Methodology used, economic evaluation type, CPS setting and type, and clinical and economic outcome results were extracted. Results were informally compared with previous systematic reviews. Of 3587 potential studies identified, 25 met inclusion criteria. Common CPS settings were hospital (36%), community (32%), and clinic or hospital-based ambulatory practices (28%). CPS types were disease state management (48%), general pharmacotherapeutic monitoring (24%), target drug programs (8%), and patient education (4%). Two studies (8%) listed CPS as medication therapy management. Costs were evaluated in 24 studies (96%) and sufficiently described in 13 (52%). Clinical or humanistic outcomes were evaluated in 20 studies (80%) and were sufficiently described in 18 (72%). Control groups were included in 16 (70%) of 23 studies not involving modeling. Study assumptions and limitations were stated and justified in eight studies (32%). Conclusions and recommendations were considered justified and based on results in 24 studies (96%). Eighteen studies (72%) involved full economic evaluation. The mean ± SD study quality score for full economic evaluations (18 studies) was 60.4 ± 22.3 of a possible 100 points. Benefit-cost ratios from three studies ranged from 1.05:1 to 25.95:1, and incremental cost-effectiveness ratios of five studies were calculated and reported. Fewer studies documented the economic impact of CPS from 2006-2010 than from 2001-2005, although a higher proportion involved controlled designs and were full economic evaluations. Evaluations of ambulatory practices were increasingly common. CPS were generally considered cost-effective or provided a good benefit-cost ratio.

Economic evaluations of clinical pharmacist interventions on hospital inpatients: a systematic review of recent literature

“…Previous review articles have broadly reached the same conclusion, the operation of additional clinical pharmacy services results in cost savings to the healthcare payer [10][11][12][13][14]. However, many published studies have been of poor quality [12,14], limiting the strength of any conclusions presented in previous reviews.…”

Attitudes of physicians, nurses and pharmacists concerning the development of clinical pharmacy activities in a university hospital

“…The physicians' fear of losing independence and professional autonomy is one of the barriers and reasons for the negative attitude towards clinical pharmacists, perceived as inspectors of their work (5,6). On the other side, there is a growing number of literature data about the positive economic impact of clinical pharmacists´ activities (7).…”

Descriptive Analysis of Acceptance by Prescribers and Economic Benefit of Pharmacist Recommended Interventions in a Critical Care Unit

“…43 In another systemic review from three studies between 2006 and 2010, Touchette et al reported benefit versus cost ratio ranges from 1.05:1 to 25.95:1, a hospital saving ranges as little as $1.05 to $25.95 for every $1 invested in clinical pharmacy. 44 The broad range of the benefit versus cost ratio can be due to a number of clinical pharmacists required per institution, the pharmacist hiring salary, and pharmacist time spent on interventions might vary in each institution.…”