Economic evaluations of clinical pharmacy services in the United States: 2011‐2017

Abstract

Studies evaluating the cost-effectiveness of clinical pharmacy services (CPS) are needed to justify implementation and reimbursement. Through a systematic review, we describe services provided by pharmacists and their economic outcomes. We conducted a literature search of published studies in PubMed, Ovid, and Embase from January 2011 through December 2017. Manuscripts evaluating a CPS with patient-level economic outcomes and conducted in the United States were included. Study risks of bias were classified by study design characteristics. Economic evaluations were classified according to the presence of a comparator, and cost and outcome measures included. The quality of full economic evaluations was assessed using the Quality of Health Economic Studies (QHES) instrument. Descriptive statistics were used to summarize CPS characteristics. After screening, 115 studies wereincluded. Type of service provided included general pharmacotherapy (41%), disease management (30%), and targeted drug program (17%). Settings included hospital (34%), ambulatory care (28%), and community pharmacy (17%). Study designs were considered high risk of bias (use of a historical control group or no control group) in 69% of cases while 25% were medium risk of bias (non-randomized with a concurrent control group) and 6% were low risk of bias (randomized experimental or multigroup interrupted time series). Economic evaluation types were descriptive studies that measured cost and/or outcomes of a CPS (55%), comparative studies that measured cost or outcomes of a CPS and a comparator (37%), and full evaluations that measured cost and outcomes of a CPS and a comparator (8%). Among nine full evaluations, the median (range) QHES score was 74 (59-95) and four reported the CPS as being more effective at a lower cost. Few full economic evaluations were conducted, but supported the cost-effectiveness of CPS. Use of a comparator group and measurement of economic inputs and outcomes would strengthen the body of evidence. K E Y W O R D Scost-benefit analysis, health services research, pharmacoeconomics, pharmacy

Impact of pharmacy-supported interventions on proportion of patients receiving non-indicated acid suppressive therapy upon discharge: A systematic review and meta-analysis

“…Additional recommendations to increase the consistency of studies describing pharmacist-led interventions include identifying data source(s), creating a data extraction instrument, training data extractors (preferably two extractors), re-evaluating a small dataset to check for agreement, and conducting appropriate statistical analysis, including cost avoidance analysis [ 94 , 97 , 98 ]. The process ultimately utilized should be published (e.g., as a supplement) for other health care providers and for administrators considering evidence-based practices for optimal pharmacy-resource allocation [ 99 ]. For example, the methodology should clearly delineate: inclusion and exclusion criteria; outcome of interests; relevant medications patients are receiving prior to arrival and during hospitalization; thorough appropriateness and inappropriateness criteria; when and how these criteria were applied to the patients’ medication lists to determine appropriateness; what tasks pharmacists were already engaged in versus new pharmacy-supported interventions; the timepoint during the patient’s hospital stay that the intervention occurred (upon admission, during stay, and/or upon discharge); detailed description of intervention; the timepoint when assessments of the interventions occurred (in real-time versus retrospectively); when another health care provider was involved with the patients’ medication reviews and at what timepoints; documentation of acceptance/rejection of pharmacist interventions and interventions made by other health care providers; patient demographics (age, gender, race/ethnicity, etc.…”

Impact of a veterans affairs primary care collaboration to provide remote team‐based care and telehealth introductory pharmacy practice experiences

“…28 A systematic review of studies conducting full economic evaluations of the value of clinical pharmacy services demonstrate costeffectiveness. 29 Studies report that pharmacist-provided CMM had a benefit to cost ratio in excess of 1, saving between $1.29 and $12 in overall health care costs for every $1 spent on CMM. 30,31 Pharmacy students make valuable contributions to patient care, offset clinical pharmacist time, and contribute to overall health care cost savings.…”

Clinical Pharmacist Integration Into Veterans' Primary Care: Team Members Perspectives

“…[20][21][22] However, CPS' training also prepares them to manage patients' multiple disease states using comprehensive medication management (CMM), which includes assessing patients' medication needs, adding drug therapies as necessary, titrating doses to achieve therapeutic levels, and assessing the appro-priateness, effectiveness, and safety across all their medications (prescription, nonprescription, alternative, traditional, vitamins, and nutritional supplements). 23 CPS' provision of these services has been shown to be a cost-effective 24 way to improve population health and intermediate clinical outcomes in diabetes, [25][26][27] hypertension, 28 and hyperlipidemia. 29 Evidence from 1 VA medical center demonstrated that approximately 27% of follow-up visits for patients with chronic illnesses in primary care could be shifted to the CPS, 30 which may allow PCP effort to be directed toward other patient care goals.…”