Cost-effectiveness of pharmacist intervention for managing hypertension in Canada
Author(s): ,
Carlo Marra
Affiliations:
BSc(Pharm) PharmD PhD
,
Karissa Johnston
Affiliations:
PhD
Valerie Santschi
Affiliations:
PhD;
Canadian Pharmacists Conference ePoster Library. Tsuyuki R. Jun 3, 2017; 180594
Prof. Dr. Ross Tsuyuki
Prof. Dr. Ross Tsuyuki
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Abstract
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Objectives
Hypertension is the single most important cause of premature morbidity and mortality in the world. Indeed, over half of all heart disease and stroke are attributable to hypertension, which is associated with approximately 10% of direct medical costs globally. Clinical trial evidence has conclusively demonstrated the benefits of pharmacist intervention – including patient education, consultation, and/or prescription – significantly reduces blood pressure, including a recent Canadian trial which found an 18.3 mmHg reduction in systolic blood pressure with pharmacist prescribing and care. Objective: To evaluate the economic impact of pharmacist management of hypertension in a Canadian setting.

Methods
A Markov cost-effectiveness model was developed to extrapolate potential differences in long-term cardiovascular and renal disease outcomes, using Framingham risk equations and other published risk equations. A range of values for systolic blood pressure reduction by pharmacists were considered (7.6-18.3 mmHg), to reflect the range of potential interventions and available evidence. The model incorporated health outcomes, costs, and quality of life to estimate an overall incremental cost-effectiveness ratio. Costs considered included direct medical costs as well as the costs associated with implementing the pharmacist intervention strategy.

Results
For a systolic blood pressure reduction of 18.3 mmHg, the estimated impact is 0.21 fewer cardiovascular events per person, and, discounted at 5% per year: 0.3 additional life years, 0.4 additional quality-adjusted life years, and $12,669 cost savings over a lifetime. As such, pharmacist care in hypertension is economically dominant, i.e., both more effective and cost-saving compared to usual care. Across a range of one-way and probabilistic sensitivity analyses of key parameters and assumptions, pharmacist intervention remained both effective and cost-saving, indicating a robustness of the analyses.

Conclusion
Pharmacist care of hypertension is not only better, but also cost saving compared to usual care. This has important public health (and pharmacy practice) implications.

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