Marra Carlo, Johnston Karissa, Santschi Valerie, Tsuyuki Ross T
School of Pharmacy (Marra), University of Otago, New Zealand; Broadstreet Health Economics & Outcomes Research (Johnston), Vancouver, BC; the School of Nursing Sciences (Santschi), University of Applied Sciences Western Switzerland, Switzerland; and Faculty of Medicine and Dentistry (Tsuyuki), University of Alberta, Edmonton, Alberta.
Can Pharm J (Ott). 2017 Mar 21;150(3):184-197. doi: 10.1177/1715163517701109. eCollection 2017 May-Jun.
More than half of all heart disease and stroke are attributable to hypertension, which is associated with approximately 10% of direct medical costs globally. Clinical trial evidence has demonstrated that the benefits of pharmacist intervention, including education, consultation and/or prescribing, can help to reduce blood pressure; a recent Canadian trial found an 18.3 mmHg reduction in systolic blood pressure associated with pharmacist care and prescribing. The objective of this study was to evaluate the economic impact of such an intervention in a Canadian setting.
A Markov cost-effectiveness model was developed to extrapolate potential differences in long-term cardiovascular and renal disease outcomes, using Framingham risk equations and other published risk equations. A range of values for systolic blood pressure reduction was considered (7.6-18.3 mmHg) to reflect the range of potential interventions and available evidence. The model incorporated health outcomes, costs and quality of life to estimate an overall incremental cost-effectiveness ratio. Costs considered included direct medical costs as well as the costs associated with implementing the pharmacist intervention strategy.
For a systolic blood pressure reduction of 18.3 mmHg, the estimated impact is 0.21 fewer cardiovascular events per person and, discounted at 5% per year, 0.3 additional life-years, 0.4 additional quality-adjusted life-years and $6,364 cost savings over a lifetime. Thus, the intervention is economically dominant, being both more effective and cost-saving relative to usual care.
Across a range of one-way and probabilistic sensitivity analyses of key parameters and assumptions, pharmacist intervention remained both effective and cost-saving.
Comprehensive pharmacist care of hypertension, including patient education and prescribing, has the potential to offer both health benefits and cost savings to Canadians and, as such, has important public health implications.
超过一半的心脏病和中风可归因于高血压，高血压在全球直接医疗费用中所占比例约为10%。临床试验证据表明，药剂师干预（包括教育、咨询和/或开处方）的益处有助于降低血压；最近一项加拿大试验发现，药剂师护理和开处方可使收缩压降低18.3 mmHg。本研究的目的是评估这种干预措施在加拿大环境中的经济影响。
使用弗雷明汉风险方程和其他已发表的风险方程，建立了一个马尔可夫成本效益模型，以推断长期心血管和肾脏疾病结果的潜在差异。考虑了一系列收缩压降低值（7.6 - 18.3 mmHg），以反映潜在干预措施的范围和现有证据。该模型纳入了健康结果、成本和生活质量，以估计总体增量成本效益比。所考虑的成本包括直接医疗成本以及实施药剂师干预策略的相关成本。
对于收缩压降低18.3 mmHg的情况，估计影响是每人心血管事件减少0.21次，按每年5%贴现，一生中可增加0.3个生命年、0.4个质量调整生命年，并节省成本6364美元。因此，该干预措施在经济上占主导地位，相对于常规护理既更有效又节省成本。
在对关键参数和假设进行的一系列单向和概率敏感性分析中，药剂师干预仍然既有效又节省成本。
对高血压进行全面的药剂师护理，包括患者教育和开处方，有可能为加拿大人带来健康益处并节省成本，因此具有重要的公共卫生意义
