Cost-effectiveness and cost-utility of hypertension and hyperlipidemia collaborative management between pharmacies and primary care in portugal alongside a trial compared with usual care (USFarmácia®)

Costa, Suzete; Guerreiro, José; Teixeira, Inês; Helling, Dennis K.; Pereira, João; Mateus, Céu

doi:10.3389/fphar.2022.903270

Cited by 2 publications

(5 citation statements)

References 46 publications

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“…Combining WTA values with incremental costs of €88.80 from previous research [ 41 ], the net benefit per patient is €788.20 and represents the monetary value of intervention patients’ welfare surplus for this collaborative model.…”

Section: Resultsmentioning

confidence: 99%

“…Baseline and 6-month trial costs are reported elsewhere [ 41 ]. We have used the estimated annual incremental costs to perform CBA.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, we developed a controlled trial to assess the effectiveness [ 40 ], cost-effectiveness and cost-utility [ 41 ], and cost-benefit of the first real-world collaborative intervention in hypertension and/or hyperlipidemia management using technology-driven data exchange between pharmacies and primary care in Portugal versus usual (fragmented) care to guide future experiments with the potential of reimbursement.…”

Section: Introductionmentioning

confidence: 99%

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Patient preferences and cost-benefit of hypertension and hyperlipidemia collaborative management model between pharmacies and primary care in Portugal: A discrete choice experiment alongside a trial (USFarmácia®)

Costa,

Guerreiro,

Teixeira

et al. 2023

PLoS ONE

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Background Little is known about patient preferences and the value of pharmacy-collaborative disease management with primary care using technology-driven interprofessional communication under real-world conditions. Discrete Choice Experiments (DCEs) are useful for quantifying preferences for non-market services. Objectives 1) To explore variation in patient preferences and estimate willingness-to-accept annual cost to the National Health Service (NHS) for attributes of a collaborative intervention trial between pharmacies and primary care using a trial exit DCE interview; 2) to incorporate a DCE into an economic evaluation using cost-benefit analysis (CBA). Methods We performed a DCE telephone interview with a sample of hypertension and hyperlipidemia trial patients 12 months after trial onset. We used five attributes (levels): waiting time to get urgent/not urgent medical appointment (7 days/45 days; 48 hrs./30 days; same day/15 days), model of pharmacy intervention (5-min. counter basic check; 15-min. office every 3 months for BP and medication review of selected medicines; 30-min. office every 6 months for comprehensive measurements and medication review of all medicines), integration with primary care (weak; partial; full), chance of having a stroke in 5 years (same; slightly lower; much lower), and annual cost to the NHS (0€; 30€; 51€; 76€). We used an experimental orthogonal fractional factorial design. Data were analyzed using conditional logit. We subtracted the estimated annual incremental trial costs from the mean WTA (Net Benefit) for CBA. Results A total of 122 patients completed the survey. Waiting time to get medical appointment—on the same day (urgent) and within 15 days (non-urgent)—was the most important attribute, followed by 30-minute pharmacy intervention in private office every 6 months for point-of-care measurements and medication review of all medicines, and full integration with primary care. The cost attribute was not significant. Intervention patients were willing to accept the NHS annual cost of €877 for their preferred scenario. The annual net benefit per patient is €788.20 and represents the monetary value of patients’ welfare surplus for this model. Conclusions This study is the first conducted in Portugal alongside a pharmacy collaborative trial, incorporating DCE into CBA. The findings can be used to guide the design of pharmacy collaborative interventions with primary care with the potential for reimbursement for uncontrolled or at-risk chronic disease patients informed by patient preferences. Future DCE studies conducted in community pharmacy may provide additional contributions. Trial registration Current Controlled Trials (ISRCTN): ISRCTN13410498, retrospectively registered on 12 December 2018.

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Section: Resultsmentioning

confidence: 99%

“…Baseline and 6-month trial costs are reported elsewhere [ 41 ]. We have used the estimated annual incremental costs to perform CBA.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patient preferences and cost-benefit of hypertension and hyperlipidemia collaborative management model between pharmacies and primary care in Portugal: A discrete choice experiment alongside a trial (USFarmácia®)

Costa,

Guerreiro,

Teixeira

et al. 2023

PLoS ONE

Self Cite

View full text Add to dashboard Cite

show abstract

“…We also collected cost data, patient-reported outcome measures (PROMs), medication adherence, and patient-reported experience measures (PREMs) for other research studies [30,31].…”

Section: Data Collectionmentioning

confidence: 99%

“…This work is part of a wider research project on the economic evaluation of a pharmacybased collaborative public health intervention with primary care providers [28][29][30][31]. Planning and conducting a well-designed trial for effectiveness and other dimensions should precede the economic evaluation of pharmacy-based public health interventions [29].…”

Section: Introductionmentioning

confidence: 99%

Real-World Effectiveness in Hypertension and Hyperlipidemia Collaborative Management between Pharmacies and Primary Care in Portugal: A Multicenter Pragmatic Controlled Trial (USFarmácia®)

Costa,

Biscaia,

Horta

et al. 2023

IJERPH

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There is evidence of the efficacy of collaborative health interventions with pharmacies and primary care providers but little of its real-world effectiveness. We aimed to assess the effectiveness and discuss the design and challenges of hypertension and hyperlipidemia management between pharmacies and primary care providers using real-world data exchange between providers and experimental bundled payment. This was a pragmatic, quasi-experimental controlled trial. We collected patient-level data from primary care prescription claims and Electronic Medical Record databases, a pharmacy claims database, and patient telephone surveys at several time points. The primary outcomes were changes in blood pressure and total cholesterol. We used matched controls with difference-in-differences estimators in a Generalized Linear Model (GLM) and controlled interrupted time series (CITS). We collected additional data for economic and qualitative studies. A total of 6 Primary Care Units, 20 pharmacies, and 203 patients entered the study. We were not able to observe significant differences in the effect of intervention vs. control. We experienced challenges that required creative strategies. This real-world trial was not able to show effectiveness, likely due to limitations in the primary care technology which affected the sample size. It offers, however, valuable lessons on methods, strategies, and data sources, paving the way for more real-world effectiveness trials to advance value-based healthcare.

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Cost-effectiveness and cost-utility of hypertension and hyperlipidemia collaborative management between pharmacies and primary care in portugal alongside a trial compared with usual care (USFarmácia®)

Cited by 2 publications

References 46 publications

Patient preferences and cost-benefit of hypertension and hyperlipidemia collaborative management model between pharmacies and primary care in Portugal: A discrete choice experiment alongside a trial (USFarmácia®)

Patient preferences and cost-benefit of hypertension and hyperlipidemia collaborative management model between pharmacies and primary care in Portugal: A discrete choice experiment alongside a trial (USFarmácia®)

Real-World Effectiveness in Hypertension and Hyperlipidemia Collaborative Management between Pharmacies and Primary Care in Portugal: A Multicenter Pragmatic Controlled Trial (USFarmácia®)

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