Tanvejsilp Pimwara, Loeb Mark, Dushoff Jonathan, Xie Feng
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Department of Pharmacy Administration, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hatyai, Songkhla, 90112, Thailand.
Pharmacoecon Open. 2018 Sep;2(3):297-308. doi: 10.1007/s41669-017-0053-0.
In Thailand, pharmaceutical care has been recently introduced to a tertiary hospital as an approach to improve adherence to tuberculosis (TB) treatment in addition to home visit and modified directly observed therapy (DOT). However, the economic impact of pharmaceutical care is not known.
The aim of this study was to estimate healthcare resource uses and costs associated with pharmaceutical care compared with home visit and modified DOT in pulmonary TB patients in Thailand from a healthcare sector perspective inclusive of out-of-pocket expenditures.
We conducted a retrospective study using data abstracted from the hospital billing database associated with pulmonary TB patients who began treatment between 2010 and 2013 in three hospitals in Thailand. We used generalized linear models to compare the costs by accounting for baseline characteristics. All costs were converted to international dollars (Intl$) RESULTS: The mean direct healthcare costs to the public payer were $519.96 (95%confidence interval [CI] 437.31-625.58) associated with pharmaceutical care, $1020.39 (95% CI 911.13-1154.11) for home visit, and $887.79 (95% CI 824.28-955.91) for modified DOT. The mean costs to patients were $175.45 (95% CI 130.26-230.48) for those receiving pharmaceutical care, $53.77 (95% CI 33.25-79.44) for home visit, and $49.33 (95% CI 34.03-69.30) for modified DOT. After adjustment for baseline characteristics, pharmaceutical care was associated with lower total direct costs compared with home visit (-$354.95; 95% CI -285.67 to -424.23) and modified DOT (-$264.61; 95% CI -198.76 to -330.46).
After adjustment for baseline characteristics, pharmaceutical care was associated with lower direct costs compared with home visit and modified DOT.
在泰国，一家三级医院最近引入了药学服务，作为除家访和改良直接观察治疗（DOT）之外提高结核病（TB）治疗依从性的一种方法。然而，药学服务的经济影响尚不清楚。
本研究的目的是从包括自付费用在内的医疗保健部门角度，估计泰国肺结核患者接受药学服务与家访和改良DOT相比的医疗资源使用情况及成本。
我们进行了一项回顾性研究，使用从泰国三家医院2010年至2013年开始治疗的肺结核患者的医院计费数据库中提取的数据。我们使用广义线性模型，通过考虑基线特征来比较成本。所有成本均换算为国际美元（Intl$）。结果：公共支付者的平均直接医疗成本，药学服务为519.96美元（95%置信区间[CI]437.31 - 625.58），家访为1020.39美元（95% CI 911.13 - 1154.11），改良DOT为887.79美元（95% CI 824.28 - 955.91）。患者的平均成本，接受药学服务的为175.45美元（95% CI 130.26 - 230.48），家访的为53.77美元（95% CI 33.25 - 79.44），改良DOT的为49.33美元（95% CI 34.03 - 69.30）。在对基线特征进行调整后，与家访（-354.95美元；95% CI -285.67至-424.23）和改良DOT（-264.61美元；95% CI -198.76至-330.46）相比，药学服务的总直接成本更低。
在对基线特征进行调整后，与家访和改良DOT相比，药学服务的直接成本更低。
