Costa Suzete, Guerreiro José, Teixeira Inês, Helling Dennis K, Pereira João, Mateus Céu
Escola Nacional de Saúde Pública (ENSP), Universidade NOVA de Lisboa, Lisboa, Portugal.
Institute for Evidence-Based Health (ISBE), Lisboa, Portugal.
Front Pharmacol. 2022 Sep 8;13:903270. doi: 10.3389/fphar.2022.903270. eCollection 2022.
There is little experience in the economic evaluation of pharmacy/primary care collaborative health interventions using interprofessional technology-driven communication under real-world conditions. This study aimed to conduct cost-effectiveness and cost-utility analyses of a collaborative care intervention in hypertension and hyperlipidemia management between pharmacies and primary care versus usual (fragmented) care alongside a trial. An economic evaluation was conducted alongside a 6-month pragmatic quasi-experimental controlled trial. Data sources included primary care clinical software; pharmacy dispensing software; patient telephone surveys; and published literature. The target population was adult patients on hypertension and/or lipid-lowering medication. The perspective was societal. We collected patient-level data on resource use to estimate trial costs. Effect outcomes included blood pressure (BP) and quality-adjusted life years (QALYs). Bootstrapping was used to estimate uncertainty around the incremental cost-effectiveness and cost-utility ratios. Cost-effectiveness planes and acceptability curves were estimated. The intervention was not shown to have reasonable levels of cost-effectiveness or cost-utility when compared to usual care as denoted by the levels of uncertainty expressed in wide confidence intervals. The probability of the intervention being cost-effective is 28% at the threshold of €20,000 per QALY gained and 57% at the threshold of €500 per mmHg systolic BP decrease. Considering the limitations of the trial which affected effectiveness and economic outcomes, our results are not generalizable for community pharmacy and primary care in Portugal. This research offers, however, valuable lessons on methods and strategies that can be used in future economic evaluations of collaborative public health interventions with the potential for reimbursement. https://www.isrctn.com/ISRCTN13410498, identifier ISRCTN13410498.
在现实世界条件下，利用跨专业技术驱动的沟通对药房/初级保健协作式健康干预措施进行经济评估的经验很少。本研究旨在对药房与初级保健机构在高血压和高脂血症管理方面的协作式护理干预措施与常规（分散式）护理进行成本效益和成本效用分析，并同时开展一项试验。在一项为期6个月的实用型准实验对照试验的同时进行了经济评估。数据来源包括初级保健临床软件、药房配药软件、患者电话调查和已发表的文献。目标人群为正在服用高血压和/或降脂药物的成年患者。采用社会视角。我们收集了患者层面的资源使用数据以估算试验成本。效果指标包括血压（BP）和质量调整生命年（QALY）。采用自抽样法估算增量成本效益比和成本效用比周围的不确定性。估算了成本效益平面和可接受性曲线。与常规护理相比，该干预措施未显示出合理水平的成本效益或成本效用，这一点由宽置信区间所表示的不确定性水平体现出来。在每获得一个QALY的成本阈值为20,000欧元时，该干预措施具有成本效益的概率为28%；在收缩压每降低1 mmHg的成本阈值为500欧元时，这一概率为57%。考虑到影响有效性和经济结果的试验局限性，我们的结果不适用于葡萄牙的社区药房和初级保健机构。然而，本研究为未来可能获得报销的协作式公共卫生干预措施的经济评估中可采用的方法和策略提供了宝贵经验。https://www.isrctn.com/ISRCTN13410498，标识符ISRCTN1341049
