Cost–Utility Analysis of a Medication Adherence Management Service Alongside a Cluster Randomized Control Trial in Community Pharmacy
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Valverde Merino, María Isabel; Martínez Martínez, Fernando; García Mochón, Leticia; Benrimoj, Shalom Isaac; Pérez Escamilla, Beatriz; Zarzuelo Romero, María José; Gastelurrutia Garralda, Miguel ÁngelEditorial
Dove Press
Materia
Chronic disease Medication adherence Health-related quality of life Cost-utility analysis Community pharmacy services Pharmacoeconomics
Date
2021-10-24Referencia bibliográfica
Valverde-Merino MI... [et al.]. Cost–Utility Analysis of a Medication Adherence Management Service Alongside a Cluster Randomized Control Trial in Community Pharmacy. Patient Prefer Adherence. 2021;15:2363-2376 [https://doi.org/10.2147/PPA.S330371]
Sponsorship
General Pharmaceutical Council of Spain; Randox LaboratoriesAbstract
Background: It is necessary to determine the cost utility of adherence interventions in
chronic diseases due to humanistic and economic burden of non-adherence.
Purpose: To evaluate, alongside a cluster-randomized controlled trial, the cost-utility of a
pharmacist-led medication adherence management service (MAMS) compared with usual
care in community pharmacies.
Materials and Methods: The trial was conducted over six months. Patients with treatments
for hypertension, asthma or chronic obstructive pulmonary disease (COPD) were included.
Patients in the intervention group (IG) received a MAMS based on a brief complex intervention,
whilst patients in the control group (CG) received usual care. The cost–utility
analysis adopted a health system perspective. Costs related to medications, healthcare
resources and adherence intervention were included. The effectiveness was estimated as
quality-adjusted life years (QALYs), using a multiple imputation missing data model. The
incremental cost–utility ratio (ICUR) was calculated on the total sample of patients.
Results: A total of 1186 patients were enrolled (IG: 633; CG: 553). The total intervention cost
was estimated to be €27.33 ± 0.43 per patient for six months. There was no statistically
significant difference in total cost of medications and healthcare resources per patient between
IG and CG. The values of EQ-5D-5L at 6 months were significantly higher in the IG [IG: 0.881 ±
0.005 vs CG: 0.833 ± 0.006; p = 0.000]. In the base case, the service was more expensive and
more effective than usual care, resulting in an ICUR of €1,494.82/QALY. In the complete case,
the service resulted in an ICUR of €2,086.30/QALY, positioned between the north-east and
south-east quadrants of the cost–utility plane. Using a threshold value of €20,000/QALY gained,
there is a 99% probability that the intervention is cost-effective.
Conclusion: The medication adherence management service resulted in an improvement in
the quality of life of the population with chronic disease, with similar costs compared to
usual care. The service is cost-effective.