Cost–Utility Analysis of a Medication Adherence Management Service Alongside a Cluster Randomized Control Trial in Community Pharmacy

Abstract

Background It is necessary to determine the cost utility of adherence interventions in chronic diseases due to humanistic and economic burden of non-adherence. Purpose To evaluate, alongside a cluster-randomized controlled trial, the cost-utility of a pharmacist-led medication adherence management service (MAMS) compared with usual care in community pharmacies. Materials and Methods The trial was conducted over six months. Patients with treatments for hypertension, asthma or chronic obstructive pulmonary disease (COPD) were included. Patients in the intervention group (IG) received a MAMS based on a brief complex intervention, whilst patients in the control group (CG) received usual care. The cost–utility analysis adopted a health system perspective. Costs related to medications, healthcare resources and adherence intervention were included. The effectiveness was estimated as quality-adjusted life years (QALYs), using a multiple imputation missing data model. The incremental cost–utility ratio (ICUR) was calculated on the total sample of patients. Results A total of 1186 patients were enrolled (IG: 633; CG: 553). The total intervention cost was estimated to be €27.33 ± 0.43 per patient for six months. There was no statistically significant difference in total cost of medications and healthcare resources per patient between IG and CG. The values of EQ-5D-5L at 6 months were significantly higher in the IG [IG: 0.881 ± 0.005 vs CG: 0.833 ± 0.006; p = 0.000]. In the base case, the service was more expensive and more effective than usual care, resulting in an ICUR of €1,494.82/QALY. In the complete case, the service resulted in an ICUR of €2,086.30/QALY, positioned between the north-east and south-east quadrants of the cost–utility plane. Using a threshold value of €20,000/QALY gained, there is a 99% probability that the intervention is cost-effective. Conclusion The medication adherence management service resulted in an improvement in the quality of life of the population with chronic disease, with similar costs compared to usual care. The service is cost-effective.

Reimbursed medication adherence enhancing interventions in 12 european countries: Current state of the art and future challenges

“…For example, a systematic review of interventions adopted in asthma management found that all of the assessed MAEIs were cost-effective considering the increased adherence rate, improved clinical effectiveness and the reduced costs of asthma care ( Khaw et al, 2021 ). Similarly, the cost of a pharmacist-led medication adherence management service for chronic patients was estimated to be €27.33 ± 0.43 per patient for 6 months, which resulted in an incremental cost-utility ratio (ICUR) of €2,086.30/QALY, thus proving that the intervention was time-consuming, yet cost-effective ( Valverde-Merino et al, 2021 ). In another study, despite increased drug costs, better medication adherence was assessed as cost-effective in chronic conditions.…”

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“…Patients with chronic conditions, such as hypertension, diabetes, asthma, and chronic obstructive pulmonary disease (COPD), face a heightened risk of non-adherence, with estimated rates of 50% for hypertension, 50-60% for asthma, and 70% for COPD (9).…”

Development of self-care in Spanish community pharmacies

“…This service improves patients' ability to optimize medication management. A Spanish study showed the effectiveness of the service for improving medication adherence, clinical outcomes 35 and quality of life 36 for patients suffering hypertension, asthma and chronic obstructive pulmonary disease. The service is not remunerated by the SNS nor any regional health system; however, a tool for improving adherence (dose administration aids) is remunerated locally in Galicia for patients over 74 years old with over 13 different medications who live alone.…”