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Research Article
5 February 2021

Medication review with follow-up for cardiovascular outcomes: a trial based cost–utility analysis

Authors: Antonio Ahumada-Canale https://orcid.org/0000-0001-6806-1422 [email protected], Constanza Vargas https://orcid.org/0000-0002-8667-1926, Carlos Balmaceda https://orcid.org/0000-0002-8381-2439, Francisco Martinez-Mardones https://orcid.org/0000-0002-7721-1813, José Cristian Plaza-Plaza https://orcid.org/0000-0003-0724-2152, Shalom Benrimoj https://orcid.org/0000-0001-9768-7838, and Victoria Garcia-Cardenas https://orcid.org/0000-0003-3770-4557Author Info & Affiliations
Volume 10, Number 3
https://doi.org/10.2217/cer-2020-0171
PDFFormats

Abstract

Aim: To assess the trial-based cost–effectiveness of medication review with follow-up compared with usual care in primary care. Materials & methods: A cluster randomized controlled trial included patients if they were independent older adults, receiving five or more prescriptions, with moderate or high cardiovascular risk. Costs were estimated from the public healthcare sector perspective, and health benefits were measured as quality-adjusted life years. Both of which were used to calculate the incremental cost–effectiveness ratio. Results: Twelve centers completed the study, six (146 patients) in the intervention group and six (145 patients) in the control group. The base-case analysis showed an incremental cost–effectiveness ratio of US$ (2019) 434.4/quality-adjusted life year (95% CI 64.20–996.03). Conclusion: The intervention was cost-effective in the public primary care setting.

Lay abstract

Aim: To assess if a pharmacy service called ‘medication review’ represents value for money to the Chilean healthcare system. Materials & methods: A trial that included older adults, receiving five or more medications, with moderate to high risk of having events such as strokes or heart attack was conducted. A cost–effectiveness analysis was performed comparing the costs and the benefits of the intervention with usual care. Results: At the end of the trial, 146 patients were on the intervention group, whereas 145 were on the control group. Medication review generated more costs, but also increased benefits. Conclusion: Medication review was good value for money for the Chilean healthcare system.

Supplementary Material

File (suppl_file.docx)

References

1.
Roth GA, Abate D, Abate KH et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392(10159), 1736–1788 (2018).
PubMed
Google Scholar
2.
Kyu HH, Abate D, Abate KH et al. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392(10159), 1859–1922 (2018).
PubMed
Google Scholar
3.
Bloom DE, Cafiero ET, Jané-Llopis E et al. The Global Economic Burden of Non-Communicable Diseases. World Economic Forum, Switzerland, Geneva, (2011).
Google Scholar
4.
Arnett DK, Blumenthal RS, Albert MA et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 140, e596–e646 (2019).
Google Scholar
5.
ADA. Standards of Medical Care in Diabetes-2020. Diabetes Care 43(January), S205–S206 (2020).
PubMed
Google Scholar
6.
Grundy SM, Stone NJ, Bailey AL et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J. Am. Coll. Cardiol. 73(24), e285–e350 (2019).
PubMed
Google Scholar
7.
Whelton PK, Carey RM, Aronow WS et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Pr. J. Am. Coll. Cardiol. 71(19), e127–e248 (2018).
PubMed
Google Scholar
8.
Seron P, Irazola V, Rubinstein A et al. Ideal cardiovascular health in the southern cone of Latin America. Public Health 156(56), 132–139 (2018).
PubMed
Google Scholar
9.
Chile Ministry of Health. Guidelines for the pharmacy fund for non-communicable diseases in primary care. 1–47 (2019). https://farmaciassc.files.wordpress.com/2019/07/orientacion-tc389cnica-fofar-2019-final-v3-002.pdf
Google Scholar
10.
Chile Ministry of Health. Chilean National Health Survey 2016–2017 V2. 1–59 (2018). www.minsal.cl/wp-content/uploads/2018/01/2-Resultados-ENS_MINSAL_31_01_2018.pdf
Google Scholar
11.
Chile Ministry of Health. Chilean National Health Survey 2016–2017 V1. 1–61 (2017). http://web.minsal.cl/wp-content/uploads/2017/11/ENS-2016-17_PRIMEROS-RESULTADOS.pdf
Google Scholar
12.
Chilean Health Superintendency. Private insured patients report 1990–2017 (2019). www.supersalud.gob.cl/documentacion/666/w3-propertyvalue-3724.html
Google Scholar
14.
PAHO/WHO. Renewing primary health care in the Americas. 1–48 (2007). www.paho.org/hq/dmdocuments/2010/Renewing_Primary_Health_Care_Americas-PAHO.pdf
Google Scholar
15.
Chile Ministry of Health. Implementation guidelines of the family medicine model. 1–143 (2012). http://web.minsal.cl/portal/url/item/e7b24eef3e5cb5d1e0400101650128e9.pdf
Google Scholar
16.
Chile Ministry of Health. Cardiovascular health program Guidelines 2017. 1–85 (2017). www.redcronicas.cl/wrdprss_minsal/wp-content/uploads/2017/08/OT-PROGRAMA-DE-SALUD-CARDIOVASCULAR_03.pdf
Google Scholar
17.
Ferrer-lues M, Daigre ML, Valdes I. Final report of Chilean Government programs: the pharmacy fund. 1–131 (2018). www.dipres.gob.cl/597/articles-177366_informe_final.pdf
Google Scholar
18.
Bossert TJ, Leisewitz T. Innovation and change in the Chilean health system. N. Engl. J. Med. 374(1), 1–5 (2016).
PubMed
Google Scholar
19.
PAHO/WHO. Primary Care Based pharmacy services. Position Paper of the PAHO/WHO. 1–106 (2013). www.paho.org/hq/dmdocuments/2013/SerieRAPSANo6-2013.pdf
Google Scholar
20.
Martínez-Mardones F, Fernandez-Llimos F, Benrimoj SI et al. Systematic review and meta-analysis of medication reviews conducted by pharmacists on cardiovascular diseases risk factors in ambulatory care. J. Am. Heart Assoc. 8(22), e013627 (2019).
PubMed
Google Scholar
21.
Drummond M, Sculpher M, Claxton K, Stoddart G, Torrance G. Principles of economic evaluation Oxford. Methods for the Economic Evaluation of Health Care Programmes (Chapter 4) (4th Edition). Oxford University Press, UK, (2015).
Google Scholar
22.
Ahumada-Canale A, Quirland C, Martinez-Mardones F, Plaza-Plaza JC, Benrimoj S, Garcia-Cardenas V. Economic evaluations of pharmacist-led medication review in outpatients with hypertension, type 2 diabetes mellitus, and dyslipidaemia: a systematic review. Eur. J. Heal. Econ. 20(7), 1103–1116 (2019).
PubMed
Google Scholar
23.
Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin. Drug Saf. 13(1), 57–65 (2014).
PubMed
Google Scholar
24.
Chile Ministry of Health. Preventive examination for older adults. 1–16 (2010). www.minsal.cl/portal/url/item/ab1f81f43ef0c2a6e04001011e011907.pdf
Google Scholar
25.
Icaza G, Núñez L, Marrugat J et al. Estimation of coronary heart disease risk in Chilean subjects based on adapted Framingham equations. Rev. Med. Chil. 137(10), 1273–1282 (2009).
PubMed
Google Scholar
26.
Scottish Government Polypharmacy Model of Care Group. Polypharmacy Guidance, Realistic Prescribing. (3rd Edition). 1–85 (2018). http://dghstatistiques.ci/assets/documents/annuaire/Annuaire-DGH-2018-v3.pdf
Google Scholar
27.
PCRG (Pharmaceutical Care Research Group). Pharmacotherapy follow-up: The Dader method (3rd revision). Pharm. Pract. (Granada) 4(1), 44–53 (2006).
Google Scholar
28.
Hoffmann TC, Glasziou PP, Boutron I et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 348(March), 1–12 (2014).
Google Scholar
29.
Ocampo CC, Garcia-Cardenas V, Martinez-Martinez F, Benrimoj SI, Amariles P, Gastelurrutia MA. Implementation of medication review with follow-up in a Spanish community pharmacy and its achieved outcomes. Int. J. Clin. Pharm. 37(5), 931–940 (2015).
PubMed
Google Scholar
30.
Vella J. Twelve Principles for Effective Adult Learning Jossey-Bass. Learning to Listen, Learning to Teach (Chapter 1). CA, USA, (2002).
Google Scholar
31.
Vella J. ]Part Two: Lessons Learned from Practice, Jossey-Bass. Training through Dialogue. CA, USA, (1995).
Google Scholar
32.
Garcia-Cardenas V, Perez-Escamilla B, Fernandez-Llimos F, Benrimoj SI. The complexity of implementation factors in professional pharmacy services. Res. Soc. Adm. Pharm. 14(5), 498–500 (2018).
PubMed
Google Scholar
33.
Castillo Riquelme M, Castillo Laborde C, Loayza Saldivia S, Aravena Pastén M. Methodological Guideline of economic evaluations of health technologies in Chile. 1–268 (2013). https://desal.minsal.cl/wp-content/uploads/2013/09/EE_FINAL_web.pdf
Google Scholar
34.
Husereau D, Drummond M, Petrou S et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS)--explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health 16(2), 231–250 (2013).
PubMed
Google Scholar
35.
Brooks R, De Charro F. EuroQol: the current state of play. Health Policy (New York) 37(1), 53–72 (1996).
PubMed
Google Scholar
36.
Zarate V, Kind P, Valenzuela P, Vignau A, Olivares-Tirado P, Munoz A. Social valuation of EQ-5D health states: the Chilean case. Value Heal. 14(8), 1135–1141 (2011).
PubMed
Google Scholar
37.
Manca A, Hawkins N, Sculpher MJ. Estimating mean QALYs in trial-based cost-effectiveness analysis: the importance of controlling for baseline utility. Health Econ. 14(5), 487–496 (2005).
PubMed
Google Scholar
38.
Chile congress library. ‘Municipal Primary Health Care Law’ (2016). www.leychile.cl/Navegar?idNorma=30745
Google Scholar
39.
40.
Chile Ministry of Health. ‘CENABAST updated prices’ (2019). www.cenabast.cl/precios-vigentes-en-contratos/
Google Scholar
41.
Aguila A, Muñoz M, Sepúlveda V. Implementation of diagnosis related groups methodology in a university hospital. Rev Med Chil 147(12), 1518–1526 (2019).
PubMed
Google Scholar
42.
Malet-Larrea A, Goyenechea E, García-Cárdenas V et al. The impact of a medication review with follow-up service on hospital admissions in aged polypharmacy patients. Br. J. Clin. Pharmacol. 82(3), 831–838 (2016).
PubMed
Google Scholar
43.
Cohen J. A coefficient of agreement for nominal scales. Educ. Psychol. Meas. 20, 37–46 (1960).
Google Scholar
44.
Fleiss J. The Measurement of Interrater Agreement. Statistical Methods for Rates and Proportions (Chapter 18). John Wiley & Sons, NY, USA (2003).
Google Scholar
45.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 33(1), 159–174 (1977).
PubMed
Google Scholar
46.
Shemilt I, Thomas J, Morciano M. A web-based tool for adjusting costs to a specific target currency and price year. Evid. Policy 6(1), 51–59 (2010).
Google Scholar
47.
IMF. ‘World Economic Outlook Database’ (2018). www.imf.org/external/pubs/ft/weo/2019/01/weodata/index.aspx
Google Scholar
48.
Faria R, Gomes M, Epstein D, White IR. A guide to handling missing data in cost-effectiveness analysis conducted within randomised controlled trials. Pharmacoeconomics 32(12), 1157–1170 (2014).
PubMed
Google Scholar
49.
Rubin D. Randomization-Based Evaluations. Multiple Imputation for Nonresponse in Surveys (Chapter 4). John Wiley & Sons, NY, USA (2004).
Google Scholar
50.
Gomes M, Grieve R, Nixon R, Ng S-W E, Carpenter J, Thompson S. Methods for covariate adjustment in cost–effectiveness analysis that use cluster randomised trials. Health Econ. 21(9), 1101–1118 (2012).
PubMed
Google Scholar
51.
Chaurasia A, Harel O. Using AIC in multiple linear regression framework with multiply imputed data. Heal. Serv. Outcomes Res. Methodol. 12(2–3), 219–233 (2012).
PubMed
Google Scholar
52.
De Leeuw J, Meijer E. Resampling Multilevel Models. Handbook of Multilevel Analysis (Chapter 11). Springer Science+Business Media, NY, USA (2008).
Google Scholar
53.
Desgagné A, Castilloux A-M, Angers J-F, LeLorier J. The use of the bootstrap statistical method for the pharmacoeconomic cost analysis of skewed data. Pharmacoeconomics 13(5), 487–497 (1998).
PubMed
Google Scholar
54.
Briggs A, Fenn P. Confidence intervals or surfaces? Uncertainty on the cost–effectiveness plane. Health Econ. 7(8), 723–740 (1998).
PubMed
Google Scholar
55.
Palmer S, Raftery J. Economic notes; opportunity costs. BMJ 318(7197), 1551–1552 (1999).
PubMed
Google Scholar
56.
WHO world health organization. Macroeconomics and health: investing in health for economic development: executive summary/report of the Commission on Macroeconomics and Health. 1–20 (2001). https://apps.who.int/iris/handle/10665/42463
Google Scholar
58.
Fenwick E, O'Brien BJ, Briggs A. Cost–effectiveness acceptability curves – facts, fallacies and frequently asked questions. Health Econ. 13(5), 405–415 (2004).
PubMed
Google Scholar
59.
Adibe MO, Aguwa CN, Ukwe CV. Cost-utility analysis of pharmaceutical care intervention versus usual care in management of Nigerian patients with Type 2 diabetes. Value Heal. Reg. Issues 2(2), 189–198 (2013).
PubMed
Google Scholar
60.
Obreli-Neto PR, Marusic S, Guidoni CM et al. Economic evaluation of a pharmaceutical care program for elderly diabetic and hypertensive patients in primary health care: a 36-month randomized controlled clinical trial. J. Manag. Care Pharm. 21(1), 66–75 (2015).
Google Scholar
61.
Kulchaitanaroaj P, Brooks JM, Chaiyakunapruk N, Goedken AM, Chrischilles EA, Carter BL. Cost-utility analysis of physician–pharmacist collaborative intervention for treating hypertension compared with usual care. J. Hypertens. 35(1), 178–187 (2017).
PubMed
Google Scholar
62.
Simpson SH, Lier DA, Majumdar SR et al. Cost-effectiveness analysis of adding pharmacists to primary care teams to reduce cardiovascular risk in patients with Type 2 diabetes: results from a randomized controlled trial. Diabet. Med. 32(7), 899–906 (2015).
PubMed
Google Scholar
63.
Jódar-Sánchez F, Malet-Larrea A, Martín JJ et al. Cost-utility analysis of a medication review with follow-up service for older adults with polypharmacy in community pharmacies in spain: the conSIGUE program. Pharmacoeconomics 33(6), 599–610 (2015).
PubMed
Google Scholar
64.
Fried TR, O'Leary J, Towle V, Goldstein MK, Trentalange M, Martin DK. Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review. J. Am. Geriatr. Soc. 62(12), 2261–2272 (2014).
PubMed
Google Scholar
65.
Cid Pedraza C, Bastías SG. Evaluation of financial status of public hospitals considering the updated costs of their services. Rev. Med. Chil. 142(2), 161–167 (2014).
PubMed
Google Scholar
|