Al Hamarneh Yazid N, Johnston Karissa, Marra Carlo A, Tsuyuki Ross T
Faculty of Medicine and Dentistry (Al Hamarneh, Tsuyuki), University of Alberta, Edmonton, Alberta.
Broadstreet Health Economics & Outcomes Research (Johnston), Vancouver, British Columbia.
Can Pharm J (Ott). 2019 Jun 10;152(4):257-266. doi: 10.1177/1715163519851822. eCollection 2019 Jul-Aug.
The REACH randomized trial demonstrated that community pharmacist prescribing and care reduced the risk for cardiovascular (CV) events by 21% compared to usual care.
To evaluate the economic impact of pharmacist prescribing and care for CV risk reduction in a Canadian setting.
A Markov cost-effectiveness model was developed to extrapolate potential differences in long-term CV outcomes, using different risk assessment equations. The mean change in CV risk for the 2 groups of REACH was extrapolated over 30 years, with costs and health outcomes discounted at 1.5% per year. The model incorporated health outcomes, costs and quality of life to estimate overall cost-effectiveness. It was assumed that the intervention would be 50% effective after 10 years. Individual-level results were scaled up to population level based on published statistics (29.2% of Canadian adults are at high risk for CV events). Costs considered included direct medical costs as well as the costs associated with implementing the pharmacist intervention. Uncertainty was explored via probabilistic sensitivity analysis.
It is estimated that the Canadian health care system would save more than $4.4 billion over 30 years if the pharmacist intervention were delivered to 15% of the eligible population. Pharmacist care would be associated with a gain of 576,689 quality-adjusted life years and avoid more than 8.9 million CV events. The intervention is economically dominant (i.e., it is both more effective and reduces costs when compared to usual care).
Across a range of 1-way and probabilistic sensitivity analyses of key parameters and assumptions, pharmacist prescribing and care are both more effective and cost-saving compared to usual care. Canadians need and deserve such care.
“拓展（REACH）”随机试验表明，与常规护理相比，社区药剂师开方和护理可将心血管（CV）事件风险降低21%。
评估在加拿大环境下药剂师开方和护理对降低CV风险的经济影响。
开发了一个马尔可夫成本效益模型，以推断长期CV结局的潜在差异，使用不同的风险评估方程。将“拓展”研究中两组CV风险的平均变化外推30年，成本和健康结局按每年1.5%进行贴现。该模型纳入了健康结局、成本和生活质量以估计总体成本效益。假设干预在10年后的有效性为50%。根据已发表的统计数据（29.2%的加拿大成年人处于CV事件高风险）将个体水平的结果扩大到人群水平。考虑的成本包括直接医疗成本以及实施药剂师干预相关的成本。通过概率敏感性分析探讨不确定性。
据估计，如果对15%的符合条件人群实施药剂师干预，加拿大医疗保健系统在30年内将节省超过44亿加元。药剂师护理将带来576,689个质量调整生命年的增益，并避免超过890万次CV事件。该干预在经济上占主导地位（即与常规护理相比，它既更有效又降低成本）。
在对关键参数和假设进行一系列单因素和概率敏感性分析中，与常规护理相比，药剂师开方和护理既更有效又节省成本。加拿大人需要且理应得到这样的护理。
