A cost-effectiveness analysis of an in-hospital clinical pharmacist service

Abstract

Setting: Two internal medicine wards at Sahlgrenska University Hospital, Göteborg, Sweden.Participants: Of 345 patients (61% women; median age: 82 years; 181 control and 164 intervention patients), 240 patients (62% women, 82 years; 124 control and 116 intervention patients) had EuroQol-5 dimensions (EQ-5D) utility scores at baseline and at 6-month follow-up.Outcome measures: Costs during a 6-month follow-up period in all patients and incremental cost-effectiveness ratio per quality-adjusted life-year (QALY) in patients with EQ-5D utility scores. Inpatient and outpatient care was extracted from the VEGA database. Drug costs were extracted from the Swedish Prescribed Drug Register. A probabilistic analysis was performed to characterise uncertainty in the costeffectiveness model. Results:No significant difference in costs between the randomisation groups was found; the mean total costs per individual6SD, intervention costs included, were V10 748613 799 (intervention patients) and V10 344614 728 (control patients) (p¼0.79). For patients in the cost-effectiveness analysis, the corresponding costs were V10 912613 999 and V9290612 885. Intervention patients gained an additional 0.0051 QALYs (unadjusted) and 0.0035 QALYs (adjusted for baseline EQ-5D utility score). These figures result in an incremental costeffectiveness ratio of V316 243 per unadjusted QALY and V463 371 per adjusted QALY. The probabilistic uncertainty analysis revealed that, at a willingness-to-pay of V50 000/QALY, the probability that the intervention was cost-effective was approximately 0.2.Conclusions: The present study reveals that an intervention designed like this one is probably not cost-effective. The study thus illustrates that the complexity of healthcare requires thorough health economics evaluations rather than simplistic interpretation of data.

Economic evaluations of clinical pharmacist interventions on hospital inpatients: a systematic review of recent literature

“…Three studies [27,28,35], achieved 'good-quality' ratings. Twelve studies were described as being of 'fair-quality' as Incremental cost-Effectiveness ratio 23 (n = 5) they did not include the cost of providing the service or intervention as part of the evaluation.…”

“…This was based on a cost of €316243 per increase in quality adjusted life year (QALY) [27]. A similar study, also conducted in Sweden reported that the total cost of secondary care per patient was US$230 lower than in intervention group over a 12 month follow up period [28].…”

“…The relevant criteria identified from the CHEERS checklist are listed in Table 2; the number of studies which successfully addressed individual criteria is also detailed. Only one study accommodated all relevant criteria [27]. The most common items to be included in studies were details of patient demographics (77 %) and a comparator (68 %).…”

“…Interventions were in following areas antimicrobial management [17][18][19][20][21][22], targeted drug programmes [23][24][25][26], multidimensional clinical pharmacy service [27][28][29], paediatric programmes [30,31], renal specialist [32,33], pharmacotherapeutic optimisation [34,35], intensive care service [36,37] and neurosurgery [38]. All intervention types have been identified in previous reviews of the literature [10][11][12][13].…”

Register or electronic health records enriched randomized pragmatic trials: The future of clinical effectiveness and cost-effectiveness trials?

“…The Scandinavian Simvastatin Survival Study (4S), used the cause of death registry and cancer registers (Strandberg et al, 2004). Similarly, a pragmatic randomized trial of an inhospital clinical pharmacist service used electronic health records and the prescribed drug register in Sweden to supplement data collected on-site to assess cost-effectiveness (Wallerstedt et al, 2012). The Standard Care Versus Celecoxib Outcome Trial (SCOT) is a trial in which electronic health records are used for patient identification and follow-up but research staff rather than clinic staff assess eligibility and recruit patients (McDonald et al, 2013).…”