Dineen-Griffin Sarah, Vargas Constanza, Williams Kylie A, Benrimoj Shalom I, Garcia-Cardenas Victoria
Graduate School of Health, University of Technology Sydney, Sydney, NSW Australia.
Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW Australia.
Cost Eff Resour Alloc. 2020 Jul 28;18:24. doi: 10.1186/s12962-020-00220-0. eCollection 2020.
A cluster randomised controlled trial (cRCT) performed from July 2018 to March 2019 demonstrated the clinical impact of a community pharmacist delivered minor ailment service (MAS) compared with usual pharmacist care (UC). MAS consisted of a technology-based face-to-face consultation delivered by trained community pharmacists. The consultation was guided by clinical pathways for assessment and management, and communication systems, collaboratively agreed with general practitioners. MAS pharmacists were trained and provided monthly practice support by a practice change facilitator. The objective of this study was to assess the cost utility of MAS, compared to UC.
Participants recruited were adult patients with symptoms suggestive of a minor ailment condition, from community pharmacies located in Western Sydney. Patients received MAS (intervention) or UC (control) and were followed-up by telephone 14-days following consultation with the pharmacist. A cost utility analysis was conducted alongside the cRCT. Transition probabilities and costs were directly derived from cRCT study data. Utility values were not available from the cRCT, hence we relied on utility values reported in the published literature which were used to calculate quality adjusted life years (QALYs), using the area under the curve method. A decision tree model was used to capture the decision problem, considering a societal perspective and a 14-day time horizon. Deterministic and probabilistic sensitivity analyses assessed robustness and uncertainty of results, respectively.
Patients (n = 894) were recruited from 30 pharmacies and 82% (n = 732) responded to follow-up. On average, MAS was more costly but also more effective (in terms of symptom resolution and QALY gains) compared to UC. MAS patients (n = 524) gained an additional 0.003 QALYs at an incremental cost of $7.14 (Australian dollars), compared to UC (n = 370) which resulted in an ICER of $2277 (95% CI $681.49-3811.22) per QALY.
Economic findings suggest that implementation of MAS within the Australian context is cost effective. Registered with Australian New Zealand Clinical Trials Registry (ANZCTR) and allocated the ACTRN: ACTRN12618000286246. Registered on 23 February 2018.
2018年7月至2019年3月进行的一项整群随机对照试验（cRCT）表明，与常规药剂师护理（UC）相比，社区药剂师提供的小病服务（MAS）具有临床影响。MAS包括由经过培训的社区药剂师提供的基于技术的面对面咨询。该咨询由评估和管理的临床路径以及与全科医生共同商定的通信系统指导。MAS药剂师接受了培训，并由实践变革促进者提供每月的实践支持。本研究的目的是评估MAS与UC相比的成本效用。
招募的参与者是来自悉尼西部社区药房的有小病症状的成年患者。患者接受MAS（干预）或UC（对照），并在与药剂师咨询后14天通过电话进行随访。在cRCT的同时进行了成本效用分析。转移概率和成本直接来自cRCT研究数据。cRCT没有提供效用值，因此我们依赖已发表文献中报告的效用值，使用曲线下面积法来计算质量调整生命年（QALYs）。使用决策树模型来捕捉决策问题，考虑社会视角和14天的时间范围。确定性和概率敏感性分析分别评估了结果的稳健性和不确定性。
从30家药房招募了患者（n = 894），82%（n = 732）的患者进行了随访。平均而言，与UC相比，MAS成本更高，但也更有效（在症状缓解和QALY增益方面）。与UC（n = 370）相比，MAS患者（n = 524）额外获得了0.003个QALYs，增量成本为7.14澳元，导致每QALY的增量成本效益比为2277澳元（95% CI 681.49 - 3811.22澳元）。
经济研究结果表明，在澳大利亚实施MAS具有成本效益。已在澳大利亚新西兰临床试验注册中心（ANZCTR）注册，并分配了ACTRN：ACTRN12618000286246。于2018年2月23日注册。
