Manchester Centre for Health Economics, Room 4.318, 4th floor, Jean Mcfarlane Building, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
Division of Pharmacy Practice and Policy, The School of Pharmacy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
Pharmacoeconomics. 2017 Dec;35(12):1237-1255. doi: 10.1007/s40273-017-0554-9.
The English community pharmacy New Medicine Service (NMS) significantly increases patient adherence to medicines, compared with normal practice. We examined the cost effectiveness of NMS compared with normal practice by combining adherence improvement and intervention costs with the effect of increased adherence on patient outcomes and healthcare costs.
We developed Markov models for diseases targeted by the NMS (hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary disease, asthma and antiplatelet regimens) to assess the impact of patients' non-adherence. Clinical event probability, treatment pathway, resource use and costs were extracted from literature and costing tariffs. Incremental costs and outcomes associated with each disease were incorporated additively into a composite probabilistic model and combined with adherence rates and intervention costs from the trial. Costs per extra quality-adjusted life-year (QALY) were calculated from the perspective of NHS England, using a lifetime horizon.
NMS generated a mean of 0.05 (95% CI 0.00-0.13) more QALYs per patient, at a mean reduced cost of -£144 (95% CI -769 to 73). The NMS dominates normal practice with a probability of 0.78 [incremental cost-effectiveness ratio (ICER) -£3166 per QALY]. NMS has a 96.7% probability of cost effectiveness compared with normal practice at a willingness to pay of £20,000 per QALY. Sensitivity analysis demonstrated that targeting each disease with NMS has a probability over 0.90 of cost effectiveness compared with normal practice at a willingness to pay of £20,000 per QALY.
Our study suggests that the NMS increased patient medicine adherence compared with normal practice, which translated into increased health gain at reduced overall cost.
ClinicalTrials.gov Trial reference number NCT01635361 ( http://clinicaltrials.gov/ct2/show/NCT01635361 ). Current Controlled trials: Trial reference number ISRCTN 23560818 ( http://www.controlled-trials.com/ISRCTN23560818/ ; DOI 10.1186/ISRCTN23560818 ). UK Clinical Research Network (UKCRN) study 12494 ( http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=12494 ).
Department of Health Policy Research Programme.
与常规实践相比，英国社区药房的新药服务（NMS）显著提高了患者对药物的依从性。我们通过将依从性提高和干预成本与增加依从性对患者结果和医疗保健成本的影响相结合，来检验 NMS 相对于常规实践的成本效益。
我们为 NMS 针对的疾病（高血压、2 型糖尿病、慢性阻塞性肺疾病、哮喘和抗血小板方案）开发了马尔可夫模型，以评估患者不依从的影响。从文献和成本关税中提取临床事件概率、治疗途径、资源使用和成本。将每个疾病的增量成本和结果分别添加到复合概率模型中，并结合试验中的依从率和干预成本。从英国国家医疗服务体系（NHS England）的角度，使用终生时间范围计算每增加一个质量调整生命年（QALY）的成本。
NMS 使每位患者平均多获得 0.05（95%置信区间 0.00-0.13）个 QALY，平均降低成本 144 英镑（95%置信区间-769 至 73）。NMS 以 0.78 的概率（增量成本效益比（ICER）-3166 英镑/QALY）主导常规实践。NMS 具有 96.7%的概率在愿意支付 20000 英镑/QALY 的情况下比常规实践更具成本效益。敏感性分析表明，针对每种疾病的 NMS 在愿意支付 20000 英镑/QALY 的情况下，比常规实践更具成本效益的概率超过 0.90。
我们的研究表明，与常规实践相比，NMS 提高了患者的药物依从性，从而在降低总成本的情况下提高了健康收益。
ClinicalTrials.gov 试验参考号 NCT01635361（http://clinicaltrials.gov/ct2/show/NCT01635361）。当前对照试验：试验参考号 ISRCTN23560818（http://www.controlled-trials.com/ISRCTN23560818/；DOI 10.1186/ISRCTN23560818）。英国临床研究网络（UKCRN）研究 12494（http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=12494）。
卫生部政策研究方案。
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