Chinthammit Chanadda, Armstrong Edward P, Warholak Terri L
Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA.
J Pharm Pract. 2012 Apr;25(2):201-8. doi: 10.1177/0897190011418512. Epub 2011 Oct 10.
This study estimated the cost-effectiveness of pharmacist discharge counseling on medication-related morbidity in both the high-risk elderly and general US population.
A cost-effectiveness decision analytic model was developed using a health care system perspective based on published clinical trials. Costs included direct medical costs, and the effectiveness unit was patients discharged without suffering a subsequent adverse drug event. A systematic review of published studies was conducted to estimate variable probabilities in the cost-effectiveness model. To test the robustness of the results, a second-order probabilistic sensitivity analysis (Monte Carlo simulation) was used to run 10 000 cases through the model sampling across all distributions simultaneously.
Pharmacist counseling at hospital discharge provided a small, but statistically significant, clinical improvement at a similar overall cost. Pharmacist counseling was cost saving in approximately 48% of scenarios and in the remaining scenarios had a low willingness-to-pay threshold for all scenarios being cost-effective. In addition, discharge counseling was more cost-effective in the high-risk elderly population compared to the general population.
This cost-effectiveness analysis suggests that discharge counseling by pharmacists is quite cost-effective and estimated to be cost saving in over 48% of cases. High-risk elderly patients appear to especially benefit from these pharmacist services.
本研究评估了药剂师出院辅导对美国高危老年人和普通人群药物相关发病率的成本效益。
基于已发表的临床试验，从医疗保健系统的角度开发了一个成本效益决策分析模型。成本包括直接医疗成本，有效性指标是出院后未发生后续药物不良事件的患者。对已发表的研究进行系统综述，以估计成本效益模型中的可变概率。为检验结果的稳健性，使用二阶概率敏感性分析（蒙特卡罗模拟）在模型中同时对所有分布进行抽样，运行10000个案例。
出院时药剂师辅导带来了微小但具有统计学意义的临床改善，总体成本相近。在约48%的情况下，药剂师辅导可节省成本，在其余情况下，所有情况的成本效益支付意愿阈值都较低。此外，与普通人群相比，出院辅导在高危老年人群中更具成本效益。
这项成本效益分析表明，药剂师进行出院辅导具有很高的成本效益，估计在超过48%的案例中可节省成本。高危老年患者似乎尤其受益于这些药剂师服务。
