Cost-Effectiveness of Pharmacist Prescribing for Managing Hypertension in the United States
Importance
Pharmacist-led interventions can significantly improve blood pressure (BP) control. The long-term cost-effectiveness of pharmacist-prescribing interventions implemented on a large scale in the US remains unclear.
Objective
To estimate the cost-effectiveness of implementing a pharmacist-prescribing intervention to improve BP control in the US.
Design, Setting, and Participants
This economic evaluation included a 5-state Markov model based on the pharmacist-prescribing intervention used in The Alberta Clinical Trial in Optimizing Hypertension (or RxACTION) (2009 to 2013). In the trial, control group patients received an active intervention, including a BP wallet card, education, and usual care. Data were analyzed from January to June 2023.
Main Outcomes and Measures
Cardiovascular (CV) events, end-stage kidney disease events, life years, quality-adjusted life years (QALYs), lifetime costs, and lifetime incremental cost-effectiveness ratio (ICER). CV risk was calculated using Framingham risk equations. Costs were based on the reimbursement rate for level 1 encounters, medication costs from published literature, and event costs from national surveys and pricing data sets. Quality of life was determined using a published catalog of EQ-5D utility values. One-way sensitivity analyses were used to assess alternative reimbursement values, a reduced time horizon of 5 years, alternative assumptions for BP reduction, and the assumption of no benefit to the intervention after 10 years. The model was expanded to the US population to estimate population-level cost and health impacts.
Results
Assumed demographics were mean (SD) age, 64 (12.5) years, 121 (49%) male, and a mean (SD) baseline BP of 150/84 (13.9/11.5) mm Hg. Over a 30-year time horizon, the pharmacist-prescribing intervention yielded 2100 fewer cases of CV disease and 8 fewer cases of kidney disease per 10 000 patients. The intervention was also associated with 0.34 (2.5th-97.5th percentiles, 0.23-0.45) additional life years and 0.62 (2.5th-97.5th percentiles, 0.53-0.73) additional QALYs. The cost savings were $10 162 (2.5th-97.5th percentiles, $6636-$13 581) per person due to fewer CV events with the pharmacist-prescribing intervention, even after the cost of the visits and medication adjustments. The intervention continued to produce benefits in more conservative analyses despite increased costs as the ICER ranged from $2093 to $24 076. At the population level, a 50% intervention uptake was associated with a $1.137 trillion in cost savings and would save an estimated 30.2 million life years over 30 years.
Conclusion and Relevance
These findings suggest that a pharmacist-prescribing intervention to improve BP control may provide high economic value. The necessary tools and resources are readily available to implement pharmacist-prescribing interventions across the US; however, reimbursement limitations remain a barrier.
Top-30
Journals
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Journal of the American Pharmacists Association : JAPhA
4 publications, 20%
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American Journal of Health-System Pharmacy
4 publications, 20%
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Clinics in Geriatric Medicine
1 publication, 5%
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Circulation: Cardiovascular Quality and Outcomes
1 publication, 5%
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Research in Social and Administrative Pharmacy
1 publication, 5%
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JAPhA Practice Innovations
1 publication, 5%
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Canadian Pharmacists Journal
1 publication, 5%
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JACCP JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY
1 publication, 5%
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Journal of Pharmaceutical Policy and Practice
1 publication, 5%
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Saudi Journal of Health Systems Research
1 publication, 5%
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International Journal of Clinical Pharmacy
1 publication, 5%
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Frontiers in Neurology
1 publication, 5%
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Healthcare
1 publication, 5%
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BMC Health Services Research
1 publication, 5%
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Publishers
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Elsevier
7 publications, 35%
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Oxford University Press
4 publications, 20%
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Springer Nature
2 publications, 10%
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Ovid Technologies (Wolters Kluwer Health)
1 publication, 5%
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SAGE
1 publication, 5%
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Wiley
1 publication, 5%
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Taylor & Francis
1 publication, 5%
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S. Karger AG
1 publication, 5%
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Frontiers Media S.A.
1 publication, 5%
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MDPI
1 publication, 5%
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- We do not take into account publications without a DOI.
- Statistics recalculated weekly.