Methods used to attribute costs avoided from pharmacist interventions in acute care: A scoping review

Abstract

Purpose Cost-avoidance studies are common in pharmacy practice literature. This scoping review summarizes, critiques, and identifies current limitations of the methods that have been used to determine cost avoidance associated with pharmacists’ interventions in acute care settings. Methods An Embase and MEDLINE search was conducted to identify studies that estimated cost avoidance from pharmacist interventions in acute care settings. We included studies with human participants and articles published in English from July 2010 to January 2021, with the intent of summarizing the evidence most relevant to contemporary practice. Results The database search retrieved 129 articles, of which 39 were included. Among these publications, less than half (18 of 39) mentioned whether the researchers assigned a probability for the occurrence of a harmful consequence in the absence of an intervention; thus, a 100% probability of a harmful consequence was assumed. Eleven of the 39 articles identified the specific harm that would occur in the absence of intervention. No clear methods of estimating cost avoidance could be identified for 7 studies. Among all 39 included articles, only 1 attributed both a probability to the potential harm and identified the cost specific to that harm. Conclusion Cost-avoidance studies of pharmacists’ interventions in acute care settings over the last decade have common flaws and provide estimates that are likely to be inflated. There is a need for guidance on consistent methodology for such investigations for reporting of results and to confirm the validity of their economic implications.

PHarmacist Avoidance or Reductions in Medical Costs in CRITically Ill Adults: PHARM-CRIT Study

“…100% probability of harm), which we recognize may not always be a valid assumption and risk overinflating CA estimates given that an adverse event would not have occurred or the intervention may have ultimately been detected by another member of the healthcare team. A recent scoping review of CA from pharmacist interventions demonstrated high risk of inflation and limited assessment of probability of harm ( 38 ). We attempted to mitigate this risk with the incorporation of a sensitivity analysis using only the CA categories with the highest levels of evidence, although only five intervention categories have CA values that come from controlled studies.…”

E“VALU”ating board certification in pharmacy

“…When incorporating financial measures, investigators are encouraged to consider defined pharmacoeconomic methods such as cost‐effectiveness, cost‐utility, cost‐benefit, or cost‐minimization studies 15 . Cost avoidance studies have been commonly reported in attempts to quantify the value of pharmacist activities, however, a recent scoping review has demonstrated that the methods are frequently flawed and report cost avoidance values that are inflated 16 . There is no consensus definition of a cost‐avoidance study, and they are generally considered to be low‐level evidence of value.…”

“…Survey instruments can be used to characterize the quality of life, patient satisfaction, and provider satisfaction 19,20 . When attempting to demonstrate value from the healthcare or payer perspectives cost‐effectiveness and cost avoidance designs may be preferred although a quality improvement, such as improvement in clinical outcomes and improvement in vaccination rates are desirable components of value 16,17 . The provider perspective of value can be demonstrated through survey instruments and collaborative/interprofessional practice scales, such as the Assessment of Interprofessional Team Collaboration Scale (AITCS) or Team Decision Making Questionnaire (TDMQ).…”

“…15 Cost avoidance studies have been commonly reported in attempts to quantify the value of pharmacist activities, however, a recent scoping review has demonstrated that the methods are frequently flawed and report cost avoidance values that are inflated. 16 There is no consensus definition of a cost-avoidance study, and they are generally considered to be low-level evidence of value. If to be considered, the investigators should follow recently published advice concerning study design.…”

“…19,20 When attempting to demonstrate value from the healthcare or payer perspectives cost-effectiveness and cost avoidance designs may be preferred although a quality improvement, such as improvement in clinical outcomes and improvement in vaccination rates are desirable components of value. 16,17 The provider perspective of value can be demonstrated through survey instruments and collaborative/interprofessional practice scales, such as the Assessment of Interprofessional Team Collaboration Scale (AITCS) or Team Decision Making Questionnaire (TDMQ). Choice of the measurement instrument that has been validated and shown to be reliable for the population or condition being evaluated is important.…”