Community pharmacist prescribing: $4.4 billion in savings

A pharmacist intervention for patients at high risk of cardiovascular disease both improves patient outcomes and saves money, according to new research

Pharmacist researchers from Canada have developed a model that quantifies the savings that a community pharmacist intervention for reducing cardiovascular risk could achieve.

The RxEACH study is the largest randomised controlled trial conducted in a community pharmacy setting.

It explored a pharmacist intervention that included patient assessment, laboratory assessment, individualised cardiovascular risk assessment and education, treatment recommendations, medication adaptation and prescribing, regular communication with the patient’s GP, and regular follow-up every month for three months.

The RxEACH study demonstrated that community pharmacist case finding, prescribing and care for patients at high risk of cardiovascular events reduced risk of events by 21% compared to usual care.

Researchers have now developed a cost-effectiveness model to explore whether there was any economic value in providing such services, and published their results in the Canadian Pharmacists Journal.

The model was developed for a population with characteristics observed in the RxEACH study.

It calculated results based on a conservative potential uptake rate of 15% of the eligible population for the intervention, over 30 years.

They estimated that at the end of the 30-year period, each individual accessing the pharmacist intervention would gain 0.11 life years and 0.19 quality-adjusted life years (QALYs), experienced 0.10 fewer cardiovascular events, and accrue $2149 less in direct medical costs compared to an individual not receiving the intervention.

For every 100 individuals accessing the intervention, it is estimated that the avoided cardiovascular events would include three cases of stroke, five myocardial infarctions, two anginas and one heart failure.

Scaled to the population level, the mean incremental cost (discounted 1.5%) associated with the intervention was a savings of more than C$4.4 billion (AUD$4.8 billion) over 30 years.

Corresponding differences in health outcomes were an additional 576,689 QALYs, 380,143 life years, and more than 8.9 million fewer cardiovascular events.

Savings reached more than C$13 billion (AUD$14 billion) over 30 years if the intervention is applied to 45% of the eligible population.

“The findings of this economic evaluation, the improved clinical outcomes in the RxEACH study, the high degree of support and appreciation for pharmacists’ full scope of practice and the fact that cardiovascaulr disease is one of the leading causes of death … indicate the need to implement such effective and less costly interventions on a wide scale as a public health service,” say the authors.

“Pharmacists, pharmacy associations and payers should seize the opportunity and join the fight against the leading cause of death in the world.”

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