A cost utility analysis alongside a cluster-randomised trial evaluating a minor ailment service compared to usual care in community pharmacy
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Amador Fernández, Noelia; Benrimoj, Shalom Isaac; García Mochón, Leticia; Gastelurrutia Garralda, Miguel Ángel; Martínez Martínez, FernandoEditorial
BMC
Materia
Community pharmacy services Primary health care Self care Self medication Nonprescription drugs Cost-utility analysis Minor ailment service
Date
2021-11-20Referencia bibliográfica
Amador-Fernández, N... [et al.]. A cost utility analysis alongside a cluster-randomised trial evaluating a minor ailment service compared to usual care in community pharmacy. BMC Health Serv Res 21, 1253 (2021). [https://doi.org/10.1186/s12913-021-07188-4]
Sponsorship
Spanish Society of Community Pharmacy; Pharmaceutical Association of ValenciaAbstract
Background: Minor ailments are “self-limiting conditions which may be diagnosed and managed without a medical
intervention”. A cluster randomised controlled trial (cRCT) was designed to evaluate the clinical, humanistic and
economic outcomes of a Minor Ailment Service (MAS) in community pharmacy (CP) compared with usual care (UC).
Methods: The cRCT was conducted for 6 months from December 2017. The pharmacist-patient intervention consisted
of a standardised face-to-face consultation on a web-based program using co-developed protocols, pharmacists’
training, practice change facilitators and patients’ educational material. Patients requesting a non-prescription
medication (direct product request) or presenting minor ailments received MAS or UC and were followed-up by
telephone 10-days after the consultation.
The primary economic outcomes were incremental cost-utility ratio (ICUR) of the service and health related quality of
life (HRQoL). Total costs included health system, CPs and patient direct costs: health professionals’ consultation time,
medication costs, pharmacists’ training costs, investment of the pharmacy and consultation costs within the 10 days
following the initial consultation. The HRQoL was obtained using the EuroQoL 5D-5L at the time of the consultation
and at 10-days follow up. A sensitivity analysis was carried out using bootstrapping. There were two sub-group
analyses undertaken, for symptom presentation and direct product requests, to evaluate possible differences.
Results: A total of 808 patients (323 MAS and 485 UC) were recruited in 27 CPs with 42 pharmacists (20 MAS and 22
UC). 64.7% (n = 523) of patients responded to follow-up after their consultation in CP. MAS patients gained an
additional 0.0003 QALYs (p = 0.053). When considering only MAS patients presenting with symptoms, the ICUR was
24,733€/QALY with a 47.4% probability of cost-effectiveness (willingness to pay of 25,000€/QALY). Although when
considering patients presenting for a direct product request, MAS was the dominant strategy with a 93.69% probability
of cost-effectiveness. Conclusions: Expanding community pharmacists’ scope through MAS may benefit health systems. To be fully cost
effective, MAS should not only include consultations arising from symptom presentation but also include an oversight
of self-selected products by patients. MAS increase patient safety through the appropriate use of non-prescription
medication and through the direct referral of patients to GP.