Ahmed Ali, Dujaili Juman Abdulelah, Chuah Lay Hong, Hashmi Furqan Khurshid, Le Long Khanh Dao, Chatha Zeenat Fatima, Khanal Saval, Awaisu Ahmed, Chaiyakunapruk Nathorn
Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia.
School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya 47500, Selangor, Malaysia.
Healthcare (Basel). 2023 Sep 1;11(17):2453. doi: 10.3390/healthcare11172453.
Evidence has shown the positive impact of pharmacist involvement on the adherence and health outcomes of people living with HIV/AIDS. However, whether such intervention provides value for money remains unclear. This study aims to fill this gap by assessing the cost-effectiveness of pharmacist interventions in HIV care in Pakistan. A Markov decision analytic model was constructed, considering clinical inputs, utility data, and cost data obtained from a randomized controlled trial and an HIV cohort of Pakistani origin. The analysis was conducted from a healthcare perspective, and the incremental cost-effectiveness ratio (ICER) was calculated and presented for the year 2023. Additionally, a series of sensitivity analyses were performed to assess the robustness of the results. Pharmacist intervention resulted in higher quality-adjusted life years (4.05 vs. 2.93) and likewise higher annual intervention costs than usual care (1979 USD vs. 429 USD) (532,894 PKR vs. 115,518 PKR). This yielded the ICER of 1383 USD/quality-adjusted life years (QALY) (372,406 PKR/QALY), which is well below the willingness-to-pay threshold of 1658 USD (446,456 PKR/QALY) recommended by the World Health Organization Choosing Interventions that are Cost-Effective. Probabilistic sensitivity analysis reported that more than 68% of iterations were below the lower limit of threshold. Sensitivity analysis reported intervention cost is the most important parameter influencing the ICER the most. The study suggests that involving pharmacists in HIV care could be a cost-effective approach. These findings could help shape healthcare policies and plans, possibly making pharmacist interventions a regular part of care for people with HIV in Pakistan.
有证据表明药剂师的参与对艾滋病毒/艾滋病感染者的依从性和健康结果有积极影响。然而，这种干预是否具有成本效益仍不清楚。本研究旨在通过评估巴基斯坦艾滋病毒护理中药剂师干预的成本效益来填补这一空白。构建了一个马尔可夫决策分析模型，考虑了从一项随机对照试验和一个巴基斯坦裔艾滋病毒队列中获得的临床数据、效用数据和成本数据。分析从医疗保健角度进行，计算了2023年的增量成本效益比（ICER）并予以呈现。此外，还进行了一系列敏感性分析以评估结果的稳健性。药剂师干预带来了更高的质量调整生命年（分别为4.05和2.93），并且与常规护理相比，年度干预成本同样更高（分别为1979美元和429美元）（分别为532,894巴基斯坦卢比和115,518巴基斯坦卢比）。这产生的ICER为1383美元/质量调整生命年（QALY）（372,406巴基斯坦卢比/QALY），远低于世界卫生组织《选择具有成本效益的干预措施》推荐的1658美元（446,456巴基斯坦卢比/QALY）的支付意愿阈值。概率敏感性分析报告称，超过68%的迭代低于阈值下限。敏感性分析报告称干预成本是对ICER影响最大的最重要参数。该研究表明，让药剂师参与艾滋病毒护理可能是一种具有成本效益的方法。这些发现有助于制定医疗保健政策和计划，可能使药剂师干预成为巴基斯坦艾滋病毒感染者护理的常规组成部分。
