Scott Anthony, Tinelli Michela, Bond Christine
Health Economics Research Unit, University of Aberdeen, Aberdeen, Scotland.
Pharmacoeconomics. 2007;25(5):397-411. doi: 10.2165/00019053-200725050-00004.
Coronary heart disease (CHD) is the most common cause of death in the UK. CHD cost the UK National Health Service (NHS) pound 3.5 billion in 2003. The economic impact of community pharmacists providing a medicines management service for patients with CHD has not been rigorously evaluated; the full economic costs of such interventions are rarely presented in the literature.
To examine the incremental costs of a 1-year community pharmacist-led medicines management service for patients with CHD in the UK, from a healthcare system and patient perspective.
A cost-minimisation analysis was conducted alongside a multicentre randomised controlled trial. The primary study participants were patients with CHD identified from general practice computer records. Patients (intervention, n = 980; control, n = 500) from 38 general practices in nine geographical areas in the UK were included in the study. INTERVENTION AND OUTCOMES MEASURES: The intervention consisted of a review of pharmaceuticals and lifestyle advice by pharmacists in their premises, with recommendations communicated to the patient's GP. The main outcome measure was the incremental cost per patient in the intervention group compared with the control group. Annual costs ( pound, 2003/4 values) included the costs of the intervention (training and delivery costs), the usual costs of NHS treatment (costs of pharmaceuticals, GP and hospital visits) and costs borne by patients. Data were collected in the 12 months before and 12 months after the intervention.
The total NHS cost increased between baseline and follow-up in both groups (from pound 1243 to pound 1286 [3%] in the control group and from pound 1410 to pound 1433 [2%] in the intervention group). The greater cost in the intervention group largely reflects the additional cost of the pharmacist training and the time taken to deliver the intervention; the difference in costs between the intervention and control groups, after controlling for differences in costs at baseline at follow-up, was statistically significant (p = 0.001). The costs of pharmaceuticals was higher in the intervention group ( pound 769.20 vs pound 742.3; p = 0.04). According to the sensitivity analysis, the intervention cost would need to decrease by 35% to achieve equivalence between costs in each arm of the trial. Difference to costs of patients and their carers at follow-up were not statistically significant.
The introduction of a 1-year pharmacist-led medicines management service is likely to increase the total cost of CHD treatment and prevention from the healthcare perspective, as the cost of the intervention outweighed the observed reduction in the cost of drugs in the intervention group. No changes in costs from the patient perspective were found.
冠心病（CHD）是英国最常见的死因。2003年，冠心病给英国国民医疗服务体系（NHS）造成了35亿英镑的损失。社区药剂师为冠心病患者提供药物管理服务的经济影响尚未得到严格评估；此类干预措施的全部经济成本在文献中很少提及。
从医疗系统和患者的角度，研究英国社区药剂师为冠心病患者提供为期1年的药物管理服务的增量成本。
在一项多中心随机对照试验的同时进行了成本最小化分析。主要研究参与者是从全科医疗计算机记录中识别出的冠心病患者。来自英国九个地理区域38家全科医疗诊所的患者（干预组，n = 980；对照组，n = 500）被纳入研究。干预措施和结果测量：干预措施包括药剂师在其场所对药物进行审查并提供生活方式建议，并将建议传达给患者的全科医生。主要结果测量指标是干预组与对照组相比每位患者的增量成本。年度成本（2003/4年英镑值）包括干预成本（培训和实施成本）、NHS常规治疗成本（药品成本、全科医生诊疗和医院就诊成本）以及患者承担的成本。在干预前12个月和干预后12个月收集数据。
两组从基线到随访期间NHS总成本均有所增加（对照组从1243英镑增至1286英镑[3%]，干预组从1410英镑增至1433英镑[2%]）。干预组成本较高主要反映了药剂师培训的额外成本以及实施干预所需的时间；在控制随访时基线成本差异后，干预组与对照组的成本差异具有统计学意义（p = 0.001）。干预组的药品成本更高（769.20英镑对742.3英镑；p = 0.04）。根据敏感性分析，干预成本需要降低35%才能使试验各臂的成本达到等效。随访时患者及其护理人员的成本差异无统计学意义。
从医疗保健角度来看，引入为期1年的药剂师主导的药物管理服务可能会增加冠心病治疗和预防的总成本，因为干预成本超过了干预组中观察到的药品成本降低。从患者角度来看，成本没有变化。
