Epidemiology Coordinating and Research Centre/Centre for Community Pharmacy Research and Interdisciplinary Strategies, University of Alberta, 8215-112 Street NW, Edmonton, Alberta, Canada.
Pharmacotherapy. 2012 Jun;32(6):527-37. doi: 10.1002/j.1875-9114.2012.01097.x. Epub 2012 May 2.
To quantify the potential cost savings of a community pharmacy-based hypertension management program based on the results of the Study of Cardiovascular Risk Intervention by Pharmacists-Hypertension (SCRIP-HTN) study in terms of avoided cardiovascular events-myocardial infarction, stroke, and heart failure hospitalization, and to compare these cost savings with the cost of the pharmacist intervention program.
An economic model was developed to estimate the potential cost avoidance in direct health care resources from reduced cardiovascular events over a 1-year period.
The SCRIP-HTN study found that patients with diabetes mellitus and hypertension who were receiving the pharmacist intervention had a greater mean reduction in systolic blood pressure of 5.6 mm Hg than patients receiving usual care. For our model, published meta-analysis data were used to compute cardiovascular event absolute risk reductions associated with a 5.6-mm Hg reduction in systolic blood pressure over 6 months. Costs/event were obtained from administrative data, and probabilistic sensitivity analyses were performed to assess the robustness of the results. Two program scenarios were evaluated-one with monthly follow-up for a total of 1 year with sustained blood pressure reduction, and the other in which pharmacist care ended after the 6-month program but the effects on systolic blood pressure diminished over time. The cost saving results from the economic model were then compared with the costs of the program. Annual estimated cost savings (in 2011 Canadian dollars) from avoided cardiovascular events were $265/patient (95% confidence interval [CI] $63-467) if the program lasted 1 year or $221/patient (95%CI $72-371) if pharmacist care ceased after 6 months with an assumed loss of effect afterward. Estimated pharmacist costs were $90/patient for 6 months or $150/patient for 1 year, suggesting that pharmacist-managed programs are cost saving, with the annual net total cost savings/patient estimated to be $131 for a program lasting 6 months or $115 for a program lasting 1 year.
Our model found that community pharmacist interventions capable of reducing systolic blood pressure by 5.6 mm Hg within 6 months are cost saving and result in improved patient outcomes. Wider adoption of pharmacist-managed hypertension care for patients with diabetes and hypertension is encouraged.
根据心血管风险干预药师高血压研究（SCRIP-HTN 研究）的结果，量化基于社区药房的高血压管理计划的潜在成本节约，具体体现在避免心血管事件（心肌梗死、中风和心力衰竭住院）方面，并将这些成本节约与药师干预计划的成本进行比较。
开发了一种经济模型，以估算在 1 年内减少心血管事件导致的直接医疗资源潜在成本节约。
SCRIP-HTN 研究发现，接受药师干预的患有糖尿病和高血压的患者，其收缩压平均降低 5.6mmHg，而接受常规护理的患者收缩压平均降低 5.6mmHg。对于我们的模型，使用已发表的荟萃分析数据来计算与 6 个月内收缩压降低 5.6mmHg 相关的心血管事件绝对风险降低。每个事件的成本来自于管理数据，并进行概率敏感性分析以评估结果的稳健性。评估了两种方案：一种是每月随访 1 年，持续降低血压；另一种是在 6 个月的项目结束后停止药师护理，但血压对降压效果随时间逐渐减弱。然后将经济模型的成本节约结果与项目成本进行比较。如果项目持续 1 年，避免心血管事件的年度估计成本节约（以 2011 年加拿大元计算）为 265 美元/患者（95%置信区间 [CI]为 63-467 美元）；如果 6 个月后停止药师护理，并且假设之后降压效果丧失，那么每年的估计成本节约为 221 美元/患者（95%CI 为 72-371 美元）。估计药师成本为 6 个月 90 美元/患者或 1 年 150 美元/患者，这表明药师管理的项目具有成本效益，每年的净总成本节约/患者估计为持续 6 个月的项目节省 131 美元，持续 1 年的项目节省 115 美元。
我们的模型发现，在 6 个月内能够降低收缩压 5.6mmHg 的社区药师干预措施具有成本效益，并可改善患者预后。鼓励更广泛地采用药师管理的高血压护理方法，为患有糖尿病和高血压的患者提供服务。
