Cost-utility analysis of medication review with follow-up for cardiovascular outcomes: A microsimulation model |
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| Institution: | 1. Graduate School of Health, University of Technology Sydney, Sydney, Australia;2. Centre for the Health Economy, Macquarie University, Sydney, Australia;3. Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia;4. Facultad de Química y de Farmacia, Pontificia Universidad Católica de Chile, Santiago, Chile;5. Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Granada, Spain;1. Department of Pharmacy, Nîmes University Hospital, Nîmes, France;2. Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, EA2415, University Institute of Clinical Research, Montpellier University, Montpellier, France;3. Department of Biostatistics, Epidemiology, Clinical Research and Health Economics, Nîmes University Hospital, Nîmes, France;4. Department of General Medicine, Nîmes University Hospital, Nîmes, France;5. Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes, France;1. AbbVie, 1 N. Waukegan Road, North Chicago, IL 60064, United States;2. Butler University, 4600 Sunset Ave, Indianapolis, IN 46208, United States;3. Michigan State University, 404 Wilson Road, East Lansing, MI 48824-1212, United States |
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| Abstract: | BackgroundCardiovascular diseases are the leading cause of death. Pharmacist-led medication review with follow-up might be cost-effective preventing cardiovascular diseases.ObjectiveTo undertake a cost–utility analysis of the addition of pharmacist-led medication review with follow-up to usual care compared to usual care alone for cardiovascular outpatients.Materials and methodsA state-transition microsimulation model was built to project outcomes over a lifetime time horizon. Inputs from a cluster randomized controlled trial conducted in primary health care centers in Chile with full-time pharmacists were used. Probabilities were estimated using patient-level data. Utilities and costs associated with each health state were obtained from the literature, whereas the intervention costs were retrieved from the trial. The public third-party payer perspective was used. Uncertainty was evaluated through one-way and probabilistic sensitivity analyses.ResultsFor the base case analysis, an incremental cost-effectiveness ratio of $963 per quality-adjusted life-year was observed which was considered cost-effective. The results were robust to sensitivity analyses and were driven by decreased cardiovascular events resulting in lower mortality.ConclusionsMedication review with follow-up was deemed a cost-effective addition to usual care with low uncertainty. |
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