Cost‐effectiveness analysis and effectiveness of pharmacist‐managed outpatient clinics in Helicobacter pylori eradication therapy

Abstract

Background Helicobacter pylori is involved in many upper gastrointestinal diseases such as peptic ulcers and gastric cancers. In this study, we compared the cost‐effectiveness of lansoprazole and vonoprazan in H. pylori eradication therapy and examined the effectiveness of pharmacist‐managed outpatient clinics. Methods We investigated the efficacy and cost‐effectiveness of pharmacist‐managed outpatient clinics in H. pylori eradication therapy at our hospital from January 2015 to December 2017. The subjects were classified into three groups: lansoprazole group; vonoprazan group; and the medication instruction group, which received instructions at the pharmacist‐managed outpatient clinics (intervention group). We examined the eradication rate and cost‐effectiveness ratio of each group. Results The eradication rate of primary eradication therapy was 75.2% in the lansoprazole group, 87.8% in the vonoprazan group and 91.4% in the intervention group. When mental component summary was used as quality of life score, cost‐effectiveness ratio was 224.7 yen in lansoprazole group, 223.9 yen in vonoprazan group and 222.2 yen in intervention group. Setting up pharmacist‐managed outpatient clinics increases the pharmacist labour cost necessary for eradication therapy. However, if the medication instructions provided by the pharmacist can lead to improved disinfection efficiency, improvement in cost efficiency can be expected. Conclusion Although medication instructions provided at the pharmacist‐managed outpatient clinics incur additional labour costs, they improve patient quality of life as well as disinfection rate in H. pylori eradication therapy. Therefore, pharmacist‐managed outpatient clinics are useful from the viewpoint of pharmacoeconomics.

A qualitative study on the development of pharmacist‐managed clinics in Taiwan

“…Pharmacist‐managed clinics (PMCs) provide outpatient services such as medication therapy management (MTM), disease management and patient education 1 . Previous studies have shown that implementing MTM has a significant impact on enhancing medication adherence, improving clinical outcomes 2–9 and achieving cost‐effectiveness 10–14 …”

Review: Treatment of Helicobacter pylori Infection 2019

“…72 In Japan, a study looked at an enhanced compliance program by getting pharmacists to provide instruction for patients being prescribed eradication therapy but found modest, if any, benefit with 91% achievement in the intervention group compared to 88% in the group getting vonoprazan without special pharmacist instruction with a slight benefit in cost-effectiveness ratio (223 vs 224). 73 A study in Israel looked at educational interventions for primary care physicians and found that a program including distribution of printed materials, educational outreach visits, and education over a social media platform improved adherence to guidelines significantly. 74 In China, it was shown that sending patients short phone text messages could increase compliance and improve adherence to therapy.…”

Pharmacist-Managed Helicobacter pylori Treatment Service Within a Gastroenterology Clinic: Workflow and Real-World Experiences

“…Prior studies evaluating pharmacists’ involvement with H pylori have primarily focused on the impact of medication counseling and adherence interventions. 8-11 Ravnan et al 8 highlighted that a telephone-based clinic, in which pharmacists evaluated the appropriateness of H pylori treatment via prescriptions and provided counseling for 42 patients, led to 100% treatment adherence with minimal adverse effects and no significant drug interactions. Al-Eidan et al 10 assessed the impact of providing counseling and 1 week of lansoprazole, amoxicillin, and clarithromycin from the hospital pharmacy (n = 38) versus standard of care (n = 38).…”

“…A total of 89% of patients in the intervention group versus 67% in the control group took >90% of medications ( P < 0.01). 11 Seko et al 9 determined the eradication rate and cost-effectiveness of pharmacists prescribing amoxicillin + clarithromycin or metronidazole + lansoprazole or vonoprazan. Eradication rates were higher in patients who received counseling from the pharmacist (91.4% vs 75.2%, respectively).…”

“…Although pharmacist-related labor costs were significant, improvement in patients’ disinfection rate and quality of life were cost-effective. 9 Finally, Morreale 12 published on a pharmacist-managed H pylori clinic within the primary care setting of a Veterans Affairs Medical Center. Patients were treated with a 14-day course of amoxicillin + omeprazole or combination of tetracycline, metronidazole, and omeprazole; bismuth formulations were not used, because of adherence concerns.…”