Wright David, Little Richard, Turner David, Thornley Tracey
School of Pharmacy, University of East Anglia, Norwich NR4 7TJ, UK.
Health Economics Consultancy, Cambridge CB23 7EQ, UK.
Pharmacy (Basel). 2019 Mar 22;7(1):30. doi: 10.3390/pharmacy7010030.
Community pharmacies are commonly used to screen for patients with diabetes. The aim of this paper is to estimate the cost per test and cost per appropriately referred patient from a pharmacy perspective using a one-year decision tree model. One-way sensitivity analysis was performed to estimate the effect of geographical location and patient self-referral rate. Data was used from 164 patients screened and located in an area with average social deprivation and largely white European inhabitants and 172 patients in an area with higher social deprivation (lower than average ability to access society's resources) and a mixed ethnicity population in England. The diabetes screening consisted of initial risk assessment via questionnaire followed by HbA1c test for those identified as high risk. The cost per person screened was estimated as £28.65. The cost per appropriately referred patient with type 2 diabetes was estimated to range from £7638 to £11,297 in deprived mixed ethnicity and non-deprived areas respectively. This increased to £12,730 and £18,828, respectively, if only 60% of patients referred chose to inform their general practitioner (GP). The cost per test and identification rates through community pharmacies was similar to that reported through medical practices. Locating services in areas of suspected greater diabetes prevalence and increasing the proportion of patients who follow pharmacist advice to attend their medical practice improves cost-effectiveness.
社区药房常用于筛查糖尿病患者。本文旨在从药房角度，使用一年期决策树模型估算每次检测的成本以及每位转诊合适患者的成本。进行了单因素敏感性分析，以估算地理位置和患者自我转诊率的影响。数据来自在一个社会剥夺程度平均且主要为白人欧洲居民的地区筛查的164名患者，以及在英国一个社会剥夺程度较高（获取社会资源能力低于平均水平）且种族混合的地区的172名患者。糖尿病筛查包括通过问卷调查进行初步风险评估，随后对被确定为高危的患者进行糖化血红蛋白（HbA1c）检测。每位筛查者的成本估计为28.65英镑。在贫困种族混合地区和非贫困地区，每位转诊合适的2型糖尿病患者的成本估计分别为7638英镑至11297英镑。如果只有60%的转诊患者选择告知其全科医生（GP），则成本分别增至12730英镑和18828英镑。通过社区药房的每次检测成本和识别率与通过医疗实践报告的相似。将服务设在疑似糖尿病患病率较高的地区，并提高遵循药剂师建议前往医疗实践的患者比例，可提高成本效益。
